Guo Liqing, Fu Yanpeng, Miao Chunyu, Wu Shuhong, Zhu Yaqiong, Liu Yuehui
Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China.
Department of Otolaryngology, Nanchang Affiliated Hospital of Sun Yat-Sen University, NanChang, 330009, JiangXi, People's Republic of China.
Int J Gen Med. 2021 Nov 25;14:8847-8861. doi: 10.2147/IJGM.S339595. eCollection 2021.
A population-based analysis of the risk of secondary primary malignancy (SPM) in patients with hypopharyngeal carcinoma (HPC) has been lacking in the literature. Therefore, we conducted this study to determine the risk factors and assess the effects of SPM on the overall survival (OS) and cancer-specific survival (CSS) of patients with HPC.
Data on selected patients diagnosed with HPC from the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015 were examined through logistic regression, Cox regression and nomogram methods.
The overall risk of SPM in patients with HPC was higher than that in the general population (SIR: 2.77; P < 0.05). The specific-site, including the oral cavity, pharynx, digestive system, respiratory system and endocrine system, had a relatively higher risk of SPM. The overall risks of the subgroup of people 55-75 years of age and all subgroups of sex, race and latency were significantly elevated. In addition, patients with HPC were more likely to have been diagnosed in 2010-2015 (vs 2004-2009; P = 0.002), to be unmarried (vs married; P = 0.008), to have distant metastasis (vs no metastasis; P = 0.016) and to have had no surgery for the first tumor (vs surgery for the first tumor; P = 0.021), and these aspects were associated with a significantly elevated risk of developing SPM. SPM was independently associated with better OS and CSS. The OS and CSS in patients with HPC with SPM were better than those in patients without SPM (log rank P < 0.0001). The C indexes of the nomogram constructed with ten influencing factors including SPM were 0.681:0.699 for OS and 0.705:0.724 for CSS (training cohort:validation cohort).
Although the overall risk of SPM in patients with HPC was elevated, SPM did not decrease the OS and CSS in patients with HPC. This finding is inconsistent with clinical observations and thus requires further research and exploration. It possibly because HPC might have a shorter survival time, or the follow-up time was not long enough.
下咽癌（HPC）患者发生第二原发性恶性肿瘤（SPM）风险的基于人群的分析在文献中尚属空白。因此，我们开展本研究以确定风险因素，并评估SPM对HPC患者总生存期（OS）和癌症特异性生存期（CSS）的影响。
通过逻辑回归、Cox回归和列线图方法，对1973年至2015年间监测、流行病学和最终结果（SEER）数据库中确诊为HPC的选定患者的数据进行分析。
HPC患者发生SPM的总体风险高于一般人群（标准化发病比：2.77；P<0.05）。特定部位，包括口腔、咽、消化系统、呼吸系统和内分泌系统，发生SPM的风险相对较高。55 - 75岁人群亚组以及所有性别、种族和潜伏期亚组的总体风险均显著升高。此外，HPC患者更有可能在2010 - 2015年被诊断（vs 2004 - 2009年；P = 0.002）、未婚（vs已婚；P = 0.008）、有远处转移（vs无转移；P = 0.016）以及未对原发肿瘤进行手术（vs对原发肿瘤进行手术；P = 0.021），而这些方面与发生SPM的风险显著升高相关。SPM与更好的OS和CSS独立相关。发生SPM的HPC患者的OS和CSS优于未发生SPM的患者（对数秩检验P<0.0001）。由包括SPM在内十个影响因素构建的列线图，OS的C指数在训练队列：验证队列为0.681:0.699，CSS为0.705:0.724。
尽管HPC患者发生SPM的总体风险升高，但SPM并未降低HPC患者的OS和CSS。这一发现与临床观察结果不一致，因此需要进一步研究和探索。这可能是因为HPC的生存时间可能较短，或者随访时间不够长。
