Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, 310008, China.
Department of Head, Neck & Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310000, China.
Eur J Surg Oncol. 2021 Sep;47(9):2286-2294. doi: 10.1016/j.ejso.2021.02.007. Epub 2021 Feb 11.
Patients with prior cancer history are commonly excluded from clinical trial. However, the impact of prior cancer on survival of patients with gastric cancer 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 gastric cancer.
Patients with gastric cancer as the primary or second primary malignancies diagnosed from 2004 to 2010 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 28,795 eligible patients with gastric cancer were included, of whom 2695 (9.35%) had a history of prior cancer. Prostate (35%), breast (12%), colon (8%), and urinary bladder (7%) malignancies were the most common prior cancer types. Patients with prior cancer history had slightly inferior overall survival (AHR = 1.06; 95% CI [1.00-1.12]; P = 0.043) but superior gastric cancer-specific survival (AHR = 0.82; 95% CI [0.76-0.88]; P < 0.001) compared with those without prior cancer. The subgroup analysis determined that a prior cancer history did not adversely affect gastric patients' clinical outcomes, except in those with prior cancer diagnosed within one year, at distant stage, or originating from lung and bronchus.
A substantial proportion of gastric cancer patients with a history of prior cancer had non-inferior clinical outcome to those without prior cancer. These patients should be considered in clinical trials.
患有既往癌症史的患者通常被排除在临床试验之外。然而，既往癌症对胃癌患者生存的影响在很大程度上尚不清楚。本研究旨在评估既往癌症的患病率，并评估其对诊断为胃癌患者生存的影响。
从监测、流行病学和最终结果（SEER）数据库中提取 2004 年至 2010 年诊断为原发性或第二原发性胃癌的患者。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 28795 例符合条件的胃癌患者，其中 2695 例（9.35%）有既往癌症史。前列腺（35%）、乳腺（12%）、结肠（8%）和膀胱癌（7%）是最常见的既往癌症类型。有既往癌症史的患者总生存略差（AHR=1.06；95%CI[1.00-1.12]；P=0.043），但胃癌特异性生存较好（AHR=0.82；95%CI[0.76-0.88]；P<0.001）。亚组分析确定，既往癌症史不会对胃癌患者的临床结局产生不利影响，但在诊断前一年、远处分期或起源于肺和支气管的患者中除外。
相当一部分有既往癌症史的胃癌患者的临床结局与无既往癌症史的患者相似。这些患者应在临床试验中考虑。
