Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, 350025 Fuzhou, Fujian, PR China.
Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 350014 Fuzhou, Fujian, PR China.
Am J Otolaryngol. 2022 Jan-Feb;43(1):103235. doi: 10.1016/j.amjoto.2021.103235. Epub 2021 Sep 15.
Prior cancer history is an important exclusion criterion from clinical trials and may decrease their generalizability. This study aimed to investigate the impact of prior cancer on the prognosis of patients with nasopharyngeal carcinoma and to describe their characteristics.
Data of patients with nasopharyngeal carcinoma diagnosed between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results database. The discrepancy in baseline characteristics was adjusted by propensity score matching. Kaplan-Meier and Cox regression analyses were performed to assess the impact of prior cancer on overall survival.
A total of 3412 individuals were identified, of which 418 (12.25%) had prior cancer. Prostate cancer was the most frequently detected type of prior cancer (18.42%). Nearly 45% of the prior cancers were diagnosed within 5 years before the nasopharyngeal carcinoma. Patients with prior cancer had an inferior survival compared to those without prior cancer (p < 0.001). Notably, patients with prior prostate, breast, hematological, and nasopharyngeal cancers had a non-inferior overall survival. Prior cancer history was an independent factor of poor overall survival (hazard ratio = 1.329, p = 0.003).
This is the first study to provide the comprehensive insight that patients with nasopharyngeal carcinoma and prior cancer have lower overall survival. Different prior cancer types had a different impact on the clinical outcome, suggesting that the exclusion criteria should be individually defined by unique cancer types.
既往癌症史是临床试验的一个重要排除标准，可能会降低其普遍性。本研究旨在探讨既往癌症对鼻咽癌患者预后的影响，并描述其特征。
从监测、流行病学和最终结果数据库中收集了 2010 年至 2015 年间诊断为鼻咽癌的患者数据。通过倾向评分匹配调整基线特征差异。采用 Kaplan-Meier 和 Cox 回归分析评估既往癌症对总生存期的影响。
共纳入 3412 例患者，其中 418 例（12.25%）有既往癌症史。前列腺癌是最常见的既往癌症类型（18.42%）。近 45%的既往癌症是在鼻咽癌确诊前 5 年内诊断的。与无既往癌症的患者相比，有既往癌症的患者生存状况较差（p<0.001）。值得注意的是，有既往前列腺癌、乳腺癌、血液系统癌症和鼻咽癌病史的患者总生存非劣效。既往癌症史是总生存不良的独立因素（危险比=1.329，p=0.003）。
这是第一项提供全面见解的研究，表明患有鼻咽癌和既往癌症的患者总生存率较低。不同类型的既往癌症对临床结局的影响不同，提示应根据特定癌症类型单独定义排除标准。
