Abstract 4860: Recommendations for enhancing inclusion and management of esophagus cancer clinical trials: Insights on mortality of esophagus cancer as a second primary malignancy

Abstract

Abstract Background: Esophagus cancer as a second primary malignancy (esophagus-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall, non-cancer related and cancer-specific survival of patients diagnosed with esophagus-2 compared to the first primary esophagus cancer (esophagus-1). Methods: We included primary esophagus cancer patients diagnosed from 1975 to 2020 in the Surveillance, Epidemiology, and End Results program. Esophagus-2 was identified in patients with a previous diagnosis of non-esophageal primary malignancy. Hazard ratios of overall, esophagus cancer-specific and non-cancer related mortality were estimated among patients with esophagus-2 compared to esophagus-1, adjusting for age, sex, tumor stage and other demographic and clinical characteristics. Results: A total of 74521 and 14820 patients were identified as esophagus-1 and esophagus-2. Esophagus-2 patients suffered lower risk of esophagus cancer-specific mortality in initial 5 years but similar risk thereafter, independent of tumor characteristics and treatment. In the first 5 years after diagnosis, patients with esophagus-2 had similar risk of overall mortality with those with esophagus-1 but increased risk thereafter. As for non-cancer related mortality, esophagus-2 patients had higher risk all along. Conclusion: Patients diagnosed with esophagus-2 face a favorable esophagus cancer-specific survival within the early period after diagnosis. However, patients with esophagus-2 are more liable to die of non-cancer cause. A conservative approach to manage esophagus-2 solely based on malignancy history is not supported but effort should be put into surveillance, prevention and management of the comorbidities and complications for the first malignancy. Citation Format: Haiyu Zhou, Jinhang Leng, Hongrui Qiu, Qizhi Huang, Jinqiang Zhang. Recommendations for enhancing inclusion and management of esophagus cancer clinical trials: Insights on mortality of esophagus cancer as a second primary malignancy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4860.