Abstract
Background: Second primary malignancy (SPM) attracts a growing attention. However, the clinical features of colon cancer (CC) survivors with SPMs are not clear and could help guide clinicians to develop a better surveillance strategy.Methods: We reviewed 56,930 CC survivors treated with colectomy from the Surveillance, Epidemiology, and End Results (SEER) database during 1998–2011. Competing risk models and nomograms were conducted for predicting the risk of occurring SPMs. The clinical utility of the models was measured by decision curve analysis (DCA) using net benefit approaches.Results: Five thousand thirteen (17.1%) of male patients developed SPMs and sites of SPMs included prostate (32.2%), lung and bronchus (11.6%), urinary bladder and kidney (10.8%), colon (10.0%), and melanoma of the skin (3.9%), while 3,592 (13.0%) of female patients occurred SPMs and sites of SPMs involved breast (25.8%), lung and bronchus (13.6%), colon (11.6%), uterus (8.2%), urinary bladder, and kidney (5.6%). Survivors with a second carcinoma of lung and bronchus showed the worst prognosis. Older age increased the risk of SPMs in both male (Subdistribution hazard ratio =2.85 [95% confidence interval = 2.53–3.21]) and female (1.80 [1.59–2.04]) survivors, especially for the risk of a second prostate carcinoma in male (5.33 [4.03–7.03]). Compared with white race, black male survivors remained at higher risk to develop the second prostate carcinoma (1.98 [1.74–2.26]). Competing-risk nomograms for CC survivors were established to help clinicians predict the probabilities of overall SPMs and prostate carcinoma. Validation of nomograms showed good discrimination and accuracy, and DCAs revealed the clinical effectiveness.Conclusions: We profiled the clinical characteristics of a large population-based cohort of CC survivors with SPMs. These features may improve future follow-up management, especially for the surveillance of second prostate cancer in men and second breast cancer in women.
Highlights
Colon cancer (CC) is the most commonly diagnosed digestive malignancy in the world [1, 2], and in 2020, it is estimated that it would be 104,610 incident cases in the United States [3]
Patients aged 20– 79 years, who were initially diagnosed as colon cancer with stage I–III between January 1998 and December 2011, and underwent colectomy were included in this study, ensuring long-term follow-up of at least 5 years to exist the risk of developing second primary malignancy (SPM)
The results showed that the concordance index (C-index) of demographic characteristics (0.587 of male survivors, 0.558 of female survivors) and tumor covariates (0.536 of male survivors, 0.532 of female survivors) in competing-risk nomograms were all smaller than the nomograms both involving demographic characteristics and tumor covariates (0.598 of male survivors, 0.568 of female survivors)
Summary
Colon cancer (CC) is the most commonly diagnosed digestive malignancy in the world [1, 2], and in 2020, it is estimated that it would be 104,610 incident cases in the United States [3]. There are a growing number of studies exploring the risk factors of SPM in different cancer survivors such as breast [7], lung [8] as well as colorectal cancer [9, 10] These studies used logistic regressions or Cox proportional hazard regressions to analyze SPM-related factors, which ignored the death as a competing event for occurring PSMs. these studies used logistic regressions or Cox proportional hazard regressions to analyze SPM-related factors, which ignored the death as a competing event for occurring PSMs They did not take into account the heterogeneity of SPM risk between colon and rectum, as well as male and female. The clinical features of colon cancer (CC) survivors with SPMs are not clear and could help guide clinicians to develop a better surveillance strategy
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