Second Primary Cancers In Patients Research Articles

SP0071 Is the Risk of Cancer after anti TNF Exposal Nule? Data from Worldwide Databases

Rheumatoid arthritis (RA) patients have an increased tumor risk compared with the general population. TNF antagonists do not increase the overall cancer risk in adults with rheumatoid arthritis. At least...

Second Primary Cancers Occurring after I-125 Brachytherapy as Monotherapy for Early Prostate Cancer

AimsProstate brachytherapy may be associated with a lower risk of radiation-induced second primary cancer (SPC) as a significantly smaller volume of normal tissue is irradiated when compared with external beam techniques. Limited data are available as it has been a routine treatment option for less than 20 years. This study identified cases of SPC in patients who underwent I-125 prostate brachytherapy as monotherapy in a single institution. Materials and methodsSPC incidence was retrieved by conducting a UK cancer registry search (Northern and Yorkshire Cancer Registry and Information Service) for 1805 consecutive patients with localised prostate cancer who received monotherapy with I-125 brachytherapy from 1995 to 2006 at a single public hospital. Of 1730 UK residents, the completeness of the registry match was 91% (1574 patients). The mean age at treatment (interquartile range) of the cohort was 63 (58–68) years with 1100 patients (70%) over the age of 60 years at treatment. The median (range) follow-up was 8 (6–10) years with 487 patients (31%) having 10 years or more. ResultsIn total, 170 patients (10.8%) were diagnosed with second primaries (1 year or more after implant); 20 of these were bladder and 10 rectal cancers. The 10 year cumulative incidences were 14.6, 1 and 0.84% for any second malignancy, bladder and rectal cancer, respectively. Only the standardised incidence rate (SIR) for bladder cancer was higher at 1.54 (95% confidence interval 0.96–2.46) compared with the general population. The SIR for bladder cancer was higher in the first few years after treatment, suggesting that the increased incidence of bladder cancer is due to increased urological surveillance. ConclusionsOverall, the incidence of SPC after I-125 is comparable with other published data with no significant excess more than 5 years from treatment. Mortality secondary to SPC of the bladder or rectum is unusual.

Second Cancer Incidence and Risk Factors in Patients With Salivary Gland Cancers

Second primary cancers (SPCs) are common in patients with head and neck squamous cell carcinoma, while the incidence and risk factors of SPC in patients with salivary gland cancers (SGCs) are largely unknown. This study aimed to examine the incidence of and risk factors for SPC in patients with SGC. To report the risk factors and incidence of SPC in patients with SGC and compare them with the values of newly developed cancers (NDCs) in a healthy population. A retrospective case-control study conducted at a university teaching hospital. The study population comprised 184 patients with SGC, without a history of cancer, who were treated between 2000 and 2010 and followed up for at least 2 years, and 200 healthy individuals (control group) who underwent medical examinations in health promotion programs during the same period. All individuals received the diagnostic scrutiny including endoscopic and radiological examinations at initial staging and at follow-up. Individuals suspected of having SPC or NDC underwent histological confirmation. Risk factors of SPC development and cumulative incidence of SPC (or NDC) in each group. The cumulative 2-, 5-, and 10-year rates of SPC were 4.4%, 8.3%, and 12.4%, respectively, and those of NDC were 1.1%, 3.4%, and 10.5%, respectively (P = .29). Except for the thyroid gland, SPC and NDC were located outside the head and neck region. Univariate analysis was unable to identify any variable significantly predictive of SPC or NDC. In the present study, there was no statistical difference in the SPC cumulative incidence between the SGC and control groups, which might result from the possible limitation of a small sample size.

18F-FDG PET/CT surveillance at 3–6 and 12 months for detection of recurrence and second primary cancer in patients with head and neck squamous cell carcinoma

Background:Early detection of recurrence of head and neck squamous cell carcinoma (HNSCC), which is often obscured by surgical or radiotherapy-induced tissue distortion, is essential for proper patient management.Methods:A total of 143 consecutive patients with previously untreated HNSCC were evaluated by whole-body fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and regular clinical follow-up after curative treatment. The 18F-FDG PET/CT was performed ∼3–6 and 12 months after treatment and findings suspicious for recurrence or SPC were confirmed using histopathology.Results:The sensitivities of 3–6- and 12-month PET/CT scans at patient level were 96% and 93%, respectively, and those of regular clinical follow-up were 11% and 19%, respectively (McNemar test, P<0.001). In patients with no clinical suspicion, PET/CT detected 95% and 91% of recurrent patients at 3–6 and 12 months, respectively. The sensitivity of PET/CT for the identification of SPC was 29% and 80% at 3–6 and 12 months, respectively. A positive interpretation of PET/CT was significantly associated with poor overall survival (log-rank test, P<0.001).Conclusion:The 18F-FDG PET/CT surveillance is beneficial for the detection of recurrence that may be missed by regular follow-up physical and endoscopic examinations of the head and neck area after curative treatment for HNSCC.

Early Detection of Recurrent Disease by FDG-PET/CT Leads to Management Changes in Patients With Squamous Cell Cancer of the Head and Neck

The objective of this study was to compare the efficacy of surveillance high-resolution computed tomography (HRCT) and physical examination/endoscopy (PE/E) with the efficacy of fluorodeoxyglucose (FDG)-positron emission tomography (PET)/HRCT for the detection of relapse in head and neck squamous cell carcinoma (HNSCC) after primary treatment. This is a retrospective analysis of contemporaneously performed FDG-PET/HRCT, neck HRCT, and PE/E in 99 curatively treated patients with HNSCC during post-therapy surveillance to compare performance test characteristics in the detection of early recurrence or second primary cancer. Relapse occurred in 19 of 99 patients (20%) during a median follow-up of 21 months (range: 9-52 months). Median time to first PET/HRCT was 3.5 months. The median time to radiological recurrence was 6 months (range: 2.3-32 months). FDG-PET/HRCT detected more disease recurrences or second primary cancers and did so earlier than HRCT or PE/E. The sensitivity, specificity, and positive and negative predictive values for detecting locoregional and distant recurrence or second primary cancer were 100%, 87.3%, 56.5%, and 100%, respectively, for PET/HRCT versus 61.5%, 94.9%, 66.7%, and 93.8%, respectively, for HRCT versus 23.1%, 98.7%, 75%, and 88.6%, respectively, for PE/E. In 19 patients with true positive PET/HRCT findings, a significant change in the management of disease occurred, prompting either salvage or systemic therapy. Of the 14 curatively treated patients, 11 were alive with without disease at a median follow-up of 31.5 months. FDG-PET/HRCT has a high sensitivity in the early detection of relapse or second primary cancer in patients with HNSCC, with significant management implications. Given improvements in therapy and changes in HNSCC biology, appropriate modifications in current post-therapy surveillance may be required to determine effective salvage or definitive therapies.

Limitation of 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography (FDG-PET) to detect early synchronous primary cancers in patients with untreated head and neck squamous cell cancer

Patients with head and neck squamous cell carcinoma (HNSCC) often develop synchronous multiple primary cancers. It is important to detect second primary cancer in HNSCC patients, because it influences treatment selection of primary cancer. The aim of this study was to evaluate the utility of 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET) for detecting synchronous primary cancers at the initial staging of patients with HNSCC. Three hundred and forty-seven patients with untreated HNSCC underwent FDG-PET with or without computed tomography fusion and other routine workups, including upper gastrointestinal Lugol chromoendoscopy, for the initial staging. We examined the prevalence of second primary cancer in these patients and the utility of PET. We identified 57 synchronous primary cancers in 53 patients, of which only 33% were detected with PET. The most common site for the second primary cancer was the esophagus (49%), followed by stomach (14%) and head and neck (11%). Most early-stage esophageal cancers and stomach cancers were detected using Lugol chromoendoscopy but not PET. Although PET is useful for detecting synchronous primary cancers, it is not a sensitive technique for detecting early esophageal cancers and gastric cancers. Therefore, Lugol chromoendoscopy is indispensable for detecting synchronous upper gastrointestinal cancers in HNSCC patients.

Mo1140 Characteristics of Second Primary Cancer in Patients With Early Gastric Cancer After Endoscopic Resection

Mo1140 Characteristics of Second Primary Cancer in Patients With Early Gastric Cancer After Endoscopic Resection

Second primary cancers in patients with hepatocellular carcinoma: a nationwide cohort study in Taiwan

There has been no large-scale population-based study on the incidence and clinical manifestations of second primary cancer (SPC) after diagnosis of hepatocellular carcinoma (HCC). This study aimed to evaluate the incidence and the risk factors of SPC following HCC diagnosis. This study used data from the National Health Insurance Research Database of Taiwan to identify all HCC patients from 1 January 1997 to 31 December 2006. Cases of SPC were gathered using the ICD9-CM codes of 140-208.91. Standardized incidence ratios (SIRs) were conducted for incidence of SPC in HCC survivors. Competing-risks regression with adjustment of death was used to analyse the risk factors of SPC. From 45976 HCC patients, 749 (1.6%) developed SPC after 90days of HCC diagnosis. Male HCC patients had higher risks of gastric, biliary, urinary bladder, kidney and haematological cancers compared to the general male population. Female patients had higher incidences of biliary tract, kidney and bone and soft tissue cancers. Older age and chronic kidney disease (CKD) were independent factors predicting SPC. SPC in patients with HCC is not rare in Taiwan. Urinary bladder cancer and renal cancer are more specific SPC for HCC patients. Better surveillance strategies for SPC should be established for HCC survivors, especially in the elderly or those with CKD.

Association between multiple cutaneous melanoma and other primary neoplasms

The risk of a subsequent cancer is an important issue for patients with melanoma. The development of a second primary cancer in patients with a solitary melanoma has been discussed in several studies. However, to our knowledge, the incidence of second primary cancer (SPC) in patients with multiple primary melanoma (MPM) has not been thoroughly investigated. To quantify the incidence of SPC in patients with MPM, with the aim of possibly developing further preventive measures. In a retrospective study, 76 patients with MPM were identified from 2155 patients being followed up at our unit. Of the 76 patients, 12 (16%) developed another neoplasm, with 59% of them having nonmelanoma skin cancer (NMSC), and 41% other noncutaneous cancers. By contrast, only 8% of those with single primary melanoma had other neoplasms (21% of whom had NMSC). Patients with MPM, especially men with skin phototype II, have a significantly increased incidence of developing SPC, particularly NMSC. Thus, careful monitoring is essential not only to detect recurrence of the original cancer or development of another primary melanoma, but also development of new malignancies of different types, particularly NMSC.

Risk and Survival of Cutaneous Melanoma Diagnosed Subsequent to a Previous Cancer

To understand the risk of cutaneous melanoma (CM) following a previous cancer. Using the Surveillance, Epidemiology, and End Results database (1988-2007), we compared a cohort of patients diagnosed as having CM as a first cancer with a cohort of patients diagnosed as having CM following a previous cancer. We included 70,819 patients with CM as a first primary cancer and 6353 patients with CM following a previous cancer. We calculated the relative risk (RR) for development of primary CM following a previous cancer and used Cox modeling to examine survival characteristics of the 2 cohorts. Patients younger than 45 years at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 11.89; 95% CI, 10.83-13.03), other nonepithelial skin cancer (RR, 2.81; 95% CI, 1.13-5.79), Kaposi sarcoma (RR, 3.26; 95% CI 1.41-6.42), female breast cancer (RR, 1.38; (1.11-1.70), and lymphoma (RR, 1.79; (95% CI, 1.30-2.41). Patients 45 years or older at first cancer diagnosis had significantly higher risk of CM following cutaneous melanoma (RR, 8.36; 95% CI, 7.93-8.81), other nonepithelial skin cancer (RR, 2.00; 95% CI 1.35-2.86), ocular melanoma (RR, 5.34; 95% CI 3.42-7.94), female breast cancer (RR, 1.12; 95% CI, 1.03-1.21), prostate cancer (RR, 1.08; 95% CI, 1.03-1.13), thyroid cancer (RR, 1.40; 95% CI, 1.06-1.82), lymphoma (RR, 1.34; 95% CI, 1.16-1.55), and leukemia (RR, 1.79; 95% CI, 1.49-2.13). Characteristics associated with better survival in both cohorts included female sex, age younger than 45 years at melanoma diagnosis, being married, being white vs black, decreasing Breslow depth, lack of tumor ulceration, no nodal involvement, and absence of metastases. Given that cutaneous melanoma is the most common second primary cancer in patients with a first CM (a risk that remains elevated for over 15 years), our results suggest the need for continued skin surveillance in melanoma survivors.

18F-FDG PET/CT and 3.0-T whole-body MRI for the detection of distant metastases and second primary tumours in patients with untreated oropharyngeal/hypopharyngeal carcinoma: a comparative study

The aim of this prospective study was to compare the diagnostic value of (18)F-FDG PET/CT and 3.0-T whole-body MRI (WB-MRI) for the assessment of distant metastases and second primary cancer (SPC) in patients with untreated oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC). A total of 103 patients were enrolled. All participants underwent 3.0-T WB-MRI and (18)F-FDG PET/CT. The diagnostic capabilities of the two imaging modalities were compared using the area under the receiver-operating-characteristic curve. Histology and follow-up data were used as the reference standard. Of the 103 patients, 18 (17.5%) were found to have either distant metastases or SPC. A total of 21 sites were involved. On a lesion-based analysis, (18)F-FDG PET/CT showed a trend toward a higher sensitivity than WB-MRI (81.0% vs. 61.9%, P = 0.125). The area under the curve (AUC) for PET/CT was also higher than for WB-MRI, although not significantly so (0.932 vs. 0.866, P = 0.189). On a patient-based analysis, the sensitivity of WB-MRI was lower than that of PET/CT (66.7% vs. 83.3%, P = 0.625). In terms of diagnostic capability, the AUC was higher for PET/CT than WB-MRI (0.886 vs. 0.813, P = 0.355). The maximal SUV of the regional lymph nodes (SUVn) above the median value (8.7 g/ml) was significantly associated with the occurrence of distant metastasis (P = 0.026). (18)F-FDG PET/CT showed a consistent trend toward higher sensitivity and diagnostic capability than 3.0-Tesla WB-MRI for the detection of distant metastases and SPCs in patients with untreated OHSCC. Our data also suggest that SUVn assessed by PET/CT can provide additional information for the prediction of distant metastases.

Second Primaries after Major Salivary Gland Cancer

To evaluate the risk of second primary cancers in patients with major salivary gland cancer using a large population database and to examine the effects of sex, salivary gland cancer histology, and radiation therapy on the risk of second primaries. Population-based study using the Surveillance, Epidemiology, and End Result (SEER) cancer database. The subjects were 15,572 men and women ages 15 and above, diagnosed with cancer of the major salivary glands from 1973 to 2006. There was an increased risk of oral cavity (standardized incidence ratio [SIR] = 3.48, P < .05), salivary (SIR = 9.97, P < .05), lung and bronchus (SIR = 1.60, P < .05), kidney (SIR = 1.68, P < .05), and thyroid (SIR = 2.66, P < .05) cancers. Men had an increased risk of developing kidney cancer (SIR = 1.70, P < .05) compared with women (SIR = 1.64, P > .05). Patients with mucoepidermoid carcinoma had an increased risk of a second salivary gland cancer (SIR = 8.97, P < .05) and thyroid cancer (SIR = 3.97, P < .05). Patients with adenoid cystic carcinoma had an increased risk of oral cavity (SIR = 3.76, P < .05) and nasopharyngeal (SIR = 16.88, P < .05) cancers. Patients with acinar cell carcinoma had an increased risk of salivary (SIR = 31.36, P < .05), kidney (SIR = 2.98, P < .05), and thyroid (SIR = 3.85, P < .05) cancers. Patients who received radiation therapy had a higher incidence of lung and bronchus (SIR = 2.11, P < .05), laryngeal (SIR = 3.08, P < .05), and thyroid (SIR = 2.95, P < .05) cancers compared with patients who did not receive radiation therapy (SIR = 1.18, 0.48, and 2.39, respectively; P > .05). Patients had an increased risk of developing second primaries, even 10 years after diagnosis of primary salivary gland cancer. Patients with major salivary gland cancers are at a risk for certain second primary cancers. This highlights the need for long-term surveillance in these patients, not only for recurrence but also for second primary cancers.

Second primary cancers and their prognostic significance in patients with renal cell carcinoma.

377 Background: To study the overall and site specific risk and prognostic significance of second primary cancers (SPC) in patients diagnosed with renal cell carcinoma (RCC). Methods: The Surveillance Epidemiology and End Results (SEER) database was queried for all patients with RCC as the first cancer and one or more SPC (1973-2006). SPC diagnosed within 1 month of diagnosis of RCC or at autopsy/death were excluded. Deidentified information was obtained to analyze the effect of SPC on overall survival (OS) of RCC patients. Results: A total of 3,795 patients with RCC and ≥ 1 SPC were identified. The ratio of observed/expected cases (O/E ratio) of RCC and ≥ 1 SPCs was 1.18 (95% C.I. 1.15-1.22), significantly greater than the general population (p&lt;0.05). The overall age-adjusted rate of SPC was 0.6 per 100,000 and rate of SPCs was higher in males and in blacks. The O/E ratio of SPCs was significantly higher in younger patients (6.6 vs. 1.3 and 1.13 for those aged &lt;30, 30-59 and ≥60 yrs respectively), in blacks (1.38 vs. 1.15 in whites), for larger tumors (1.3, 1.2 and 1.05 for tumors &lt;5cm, 5-&lt;10cm and ≥10cm in diameter), and those who did not receive radiation. The risk was similar for both genders. There was variation in the site-specific risk of SPC depending on age at time of RCC diagnosis, gender, race, size of the tumor and presence or lack of radiation therapy. Patients with SPC had longer OS than those with RCC as the only primary tumor on univariate but not multivariate analysis. Older age (≥60yrs), radiation therapy, and a short interval (&lt;12 mo) between the diagnosis of RCC and a SPC were associated with significantly shorter OS in RCC patients with SPC on multivariate analysis. Conclusions: Our comprehensive analysis of SPCs in patients with RCC as the first primary malignancy using SEER data suggests that about 10% of RCC patients develop SPC and that several patient, tumor and treatment-related factors affect the risk of SPC at specific sites. Further, SPC can adversely influence the prognosis of patients with RCC, especially those &gt;60 years old, receiving radiation or diagnosed with a SPC within 1 year after RCC diagnosis. These results may have significance in planning surveillance strategies to improve the survival of patients with RCC. No significant financial relationships to disclose.

Racial Disparities in Risk of Second Primary Cancers in Patients With Endometrial Cancer: Analysis of SEER Data

INTRODUCTION: Endometrial cancer (EC) is the most common gynecologic cancer in the United States. Racial disparities in the incidence and mortality of this cancer are apparent; black women are less likely to develop this malignancy, and yet are more likely to die when diagnosed. Racial differences of second primary cancer (SPC) have not been examined and are the goal of this study. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, SPC risk in white and black EC cases was compared to the general population and to women with other primary cancers. Standardized incidence ratios (SIRs) of SPC (overall and by tumor site) with 95% confidence intervals were calculated. Poisson regression was used to estimate the race-specific risk of SPC in EC cases treated with radiotherapy vs. non-irradiated cases. RESULTS: The analysis included 11,047 EC cases diagnosed between 1973 and 2007 that developed a SPC. Overall risk of SPC in white EC cases was significantly lower than the general population (SIR=0.85, 95% CI: 0.84, 0.87), but significantly higher in black EC cases (SIR=1.19, 95% CI: 1.08, 1.31). White EC cases treated with radiotherapy were more likely to develop SPC compared to non-irradiated cases (IRR=1.18, 95% CI: 1.14, 1.23). CONCLUSIONS: This is the first analysis of race-specific SPC risk in EC cases and it suggests differences between white and black cases. Although exploratory, these data provide important clues about the etiology of SPC in patients with EC. This analysis also highlights the need for careful monitoring following diagnosis and treatment of EC.

Elevated risk of second primary cancer in patients with cutaneous malignant melanoma: A nationwide cohort study in Taiwan

It has been described that Caucasian patients with cutaneous malignant melanoma (CMM) are at an increased risk of developing second primary cancer. However, no large-scale study of second primary cancer in CMM patients has been conducted among Asians, who have distinctly different skin types. We sought to access the risk of second primary cancer among CMM patients based on data from a nationwide database in Taiwan. Utilizing the catastrophic illness database of Taiwan's National Health Insurance Research Database, we identified 2665 CMM patients without prior cancers in the period from 1997 to 2008. The standard incidence ratio (SIR) of each cancer was calculated. The mean age ± standard deviation at diagnosis of CMM was 62.2 ± 17.4 years. The mean annual incidence was 0.9 cases per 100,000 people. The overall cancer risk was elevated (SIR: 2.54), with younger patients having a higher risk. The risk remained elevated during the first five years after the CMM diagnosis. CMM patients had a higher risk of developing cancers of eye (SIR: 275.68), connective tissue (SIR: 43.45), brain (SIR: 21.03), and non-melanoma skin cancer (SIR: 17.71). CMM patients have a 2.54-fold risk of second primary cancer, with younger patients at increased risk. The risk remains elevated during the first five years after the diagnosis of CMM. The sites with highest risk of second primary cancer are eye, connective tissue, brain, and non-melanoma skin cancer.

Second primary cancers in patients with gastric cancer

BackgroundThe risk of developing a second primary tumour in patients with gastric carcinoma is higher than among the general population. The aim was to investigate the clinicopathological characteristics of the second primary cancers in patients with gastric cancer in this study.Patients and methodsIn the retrospective study, patients with gastric cancers were evaluated between 1995 and 2005 for primary tumours according to Warren and Gates’ criteria related with the second primary cancers.ResultsNine of the 112 patients with gastric cancer had second primary cancers. Seven of the patients were males and two females. Six patients with gastric cancers had synchronous, and three had metachronous tumours. The age of the patients ranged from 53 to 78 years, and the mean age was 61 ± 8.3 years. The most frequent site of occurrence of the second tumours was the colo-rectum (33%) followed by the upper respiratory system (22%), and the urogenital system (22%) in descending order of frequency.ConclusionsThe incidence of the second primary cancer in gastric cancer patients was 8% in the current report. It is recommended that careful preoperative and postoperative examinations for other primary cancers, as well as for the extent of the primary gastric carcinoma, are carried out. Because colorectal cancer was the most common carcinoma combined with gastric carcinoma, the surveillance for this carcinoma (e.g., colonoscopy, abdominopelvic CT) would be appropriate after the diagnosis of gastric carcinoma.

Role of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Preoperative Staging of Early Glottic Cancer

ResultsZZIn detecting regional metastasis, the sensitivity and specificity of FDG-PET/CT were 66.67% and 97.25%, respectively, with the positive predictive value (PPV) of 40%, the negative predictive value (NPV) of 99.16%, and the accuracy of 96.77%. The sensitivity, specificity, PPV, NPV and accuracy of neck CT were 66.67%, 96.69%, 33.33%, 99.15%, and 95.96%, respectively. The suspicious distant metastasis (n=1) and second primary cancers (n=7) were observed in FDG-PET/CT. The true second primary cancers occurred at the colon (n=1) and the prostate (n=2). The other cases were proved to be false positive. Distant metastasis and second primary cancers were not detected by the conventional work-up tests. ConclusionZZThe regional metastasis detection rate of FDG-PET/CT was similar to those of the conventional work-up tests. However, compared to the conventional tests, FDG-PET/CT is useful for detecting distant metastasis or second primary cancers in patients with early glottic cancer. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:419-24 Key WordsZZPositron-emission tomography/computed tomography·Larynx cancer·Neoplasm metastasis·Second primary neoplasm.

Retinoid Chemoprevention Trials: Cyclin D1 in the Crosshairs

Successful clinical cancer chemoprevention with retinoids was promised by compelling preclinical and early clinical evidence. Indeed, the concept of cancer chemoprevention came largely from studies showing retinoid suppression of epithelial carcinogenesis ([1][1]–[4][2]). Yet, randomized phase III

Two Sites of Head and Neck Squamous Cell Carcinoma: Utility of Loss of Heterozygosity

The prevalence of distant metastasis and second primary tumors is increasing with improved locoregional control in patients with head and neck squamous cell carcinoma. Traditionally, clinicopathologic evidence has been the gold standard used to distinguish distant metastasis from second primary tumors. We report a case in which loss of heterozygosity testing was used to clarify the clonal relationship between the 2 sites of head and neck squamous cell carcinoma. A patient with squamous cell carcinoma in the larynx and mandible underwent loss of heterozygosity testing. The loss of heterozygosity testing confirmed that the mandibular cancer was a metastatic presentation of the laryngeal squamous cell carcinoma. We conclude that loss of heterozygosity testing can be useful in differentiating distant metastasis from second primary cancers in patients with 2 sites of head and neck squamous cell carcinoma, consequently providing important prognostic and staging information.

Re: Second primary cancers in patients with nasopharyngeal carcinoma: a pooled analysis of 13 cancer registries

In the above-captioned paper [1], Scelo and colleagues present a pooled analysis of the occurrence of second primary cancers in nasopharyngeal carcinoma (NPC) patients from 13 cancer registries from Europe, Canada, Australia, and Singapore. This paper provides an important contribution as previous studies of second malignancies, following NPC, have been based on small sample sizes. However, there is a serious methodological issue arising from their study that needs to be discussed. Although the authors justifiably stratify the analysis, geographically into high risk (Singapore) and low risk (Europe, Canada, and Australia) areas, there is no mention in the paper of stratification by race or ethnicity.