The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, P. R. China.
Department of Medical Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, P. R. China.
Cancer Med. 2020 Nov;9(21):8029-8042. doi: 10.1002/cam4.3442. Epub 2020 Sep 15.
Second primary malignancy (SPM) ranks the second leading cause of death in patients with head and neck cancer (HNC), while studies exploring the risk factors for SPM are limited. To clarify this, we investigated the relationship between the chemotherapy and SPM using the Surveillance, Epidemiology, and End Results (SEER) database. 11 345 patients initially diagnosed with HNC between 1998 and 2016 were selected from the SEER database. First, these patients were divided into two groups according to chemotherapy or not. With Fine and Gray model, the subdistribution hazard ratio (sHR) of chemotherapy was calculated based on Propensity Score Matching (PSM). Second, the 11 345 cases were randomized into a training set and a validation set. Based on the training set, the different cumulative incidence of SPMs between the patients with and without chemotherapy was estimated respectively in the high- and low-risk group according to the scores derived from a nomogram. Chemotherapy was negatively correlated to the SPMs (sHR: 0.847, 95% CI: 0.733-0.977, P = .023) by conducting competing risk analysis. With chemotherapy, forest plots showed subgroups of squamous cell carcinoma (SCC, sHR: 0.815, 95% CI: 0.7-0.948, P = .008), 50-64 years old (sHR:0.794, 95% CI: 0.655-0.962, P = .019), male (sHR:0.828, 95% CI: 0.703-0.974, P = .023), and well/moderate histological grade (sHR:0.828, 95% CI: 0.688-0.996, P = .045) were negatively correlated to SPMs; the nomogram showed the high-risk population characterized as SCC, elder age, male, and well/moderate histological grade also tended to have lower incidence of SPMs (sHR: 0.805, 95% CI: 0.669-0.969, P = .022). Despite HNC patients with characteristics of SCC, increased age, male, and well/moderate histological grade had higher risk of a SPM, they were also more likely to be benefitted from chemotherapy to avoid it.
第二原发恶性肿瘤（SPM）是头颈部癌症（HNC）患者死亡的第二大主要原因，而探索 SPM 风险因素的研究有限。为了阐明这一点，我们使用监测、流行病学和最终结果（SEER）数据库研究了化疗与 SPM 之间的关系。从 SEER 数据库中选择了 1998 年至 2016 年间最初被诊断为 HNC 的 11345 名患者。首先，根据是否接受化疗将这些患者分为两组。使用 Fine 和 Gray 模型，根据倾向评分匹配（PSM）计算化疗的亚分布风险比（sHR）。其次，将 11345 例随机分为训练集和验证集。基于训练集，根据列线图得出的评分，分别估计化疗患者和无化疗患者在高风险组和低风险组的 SPM 不同累积发生率。通过竞争风险分析，化疗与 SPM 呈负相关（sHR：0.847，95%CI：0.733-0.977，P=0.023）。在接受化疗的情况下，森林图显示了鳞状细胞癌（SCC，sHR：0.815，95%CI：0.7-0.948，P=0.008）、50-64 岁（sHR：0.794，95%CI：0.655-0.962，P=0.019）、男性（sHR：0.828，95%CI：0.703-0.974，P=0.023）和组织学分级良好/中等（sHR：0.828，95%CI：0.688-0.996，P=0.045）与 SPM 呈负相关；列线图显示，具有 SCC、年龄较大、男性和组织学分级良好/中等特征的高危人群也倾向于 SPM 发生率较低（sHR：0.805，95%CI：0.669-0.969，P=0.022）。尽管具有 SCC、年龄较大、男性和组织学分级良好/中等特征的 HNC 患者发生 SPM 的风险较高，但他们也更有可能受益于化疗以避免 SPM。
