Department of otolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, P. R. China.
BMC Cancer. 2020 Nov 23;20(1):1137. doi: 10.1186/s12885-020-07634-2.
Patients with a prior history of cancer are commonly excluded from clinical trial. Increasing number of studies implied that a prior cancer did not adversely affect the clinical outcome among various types of cancer patients. However, the impact of prior cancer on survival of larynx cancer patients remains largely unknown. The aim of this study was to evaluate the prevalence of prior cancer and assess its impact on survival of patients diagnosed with larynx cancer.
Patients with larynx cancer as the first or second primary malignancy diagnosed from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. Kaplan-Meier method, multivariate Cox proportional hazard model, and multivariate competing risk model were performed for survival analysis.
A total of 24,812 eligible patients with larynx cancer were included in the study, wherein a total of 2436 patients (9.8%) had a prior history of cancer. Prostate (36%), lung and bronchus (10%), urinary bladder (7%), and breast (6%) were the most common types of prior cancer. A prior cancer history served as a risk factor for overall survival (AHR =1.30; 95% CI [1.21-1.41]; P < 0.001) but a protective factor for cancer-specific mortality (AHR = 0.83; 95% CI [0.72-0.94]; P = 0.004) in comparison with those without prior cancer. The subgroup analysis showed that a prior history of cancer adversely affected overall survival of patients with larynx cancer in most subgroups stratified by timing and types of prior cancer, as well as by different clinicopathologic features.
Our study indicated an adverse survival impact of a prior history of cancer on patients with larynx cancer. Except for a few particular prior cancer, clinical trials should be considered prudently for laryngeal cancer patients with prior cancers.
患有既往癌症史的患者通常被排除在临床试验之外。越来越多的研究表明，既往癌症不会对各种类型的癌症患者的临床结局产生不利影响。然而，既往癌症对喉癌患者生存的影响在很大程度上仍不清楚。本研究旨在评估既往癌症的患病率，并评估其对诊断为喉癌患者生存的影响。
从监测、流行病学和最终结果（SEER）数据库中提取 2004 年至 2015 年间作为首发或第二原发恶性肿瘤诊断的喉癌患者。采用倾向评分匹配（PSM）平衡基线特征。采用 Kaplan-Meier 法、多变量 Cox 比例风险模型和多变量竞争风险模型进行生存分析。
共纳入 24812 例符合条件的喉癌患者，其中 2436 例（9.8%）有既往癌症史。前列腺癌（36%）、肺癌和支气管癌（10%）、膀胱癌（7%）和乳腺癌（6%）是最常见的既往癌症类型。既往癌症史是总生存的危险因素（AHR=1.30；95%CI[1.21-1.41]；P<0.001），但与无既往癌症的患者相比，是癌症特异性死亡率的保护因素（AHR=0.83；95%CI[0.72-0.94]；P=0.004）。亚组分析显示，在按既往癌症发生时间和类型以及不同临床病理特征分层的大多数亚组中，既往癌症史对喉癌患者的总生存均有不利影响。
本研究表明，既往癌症史对喉癌患者的生存有不利影响。除了少数特定的既往癌症外，对于有既往癌症的喉癌患者，应谨慎考虑临床试验。
