Ye Jiayue, Hu Sheng, Zhang Wenxiong, Zhang Deyuan, Zhang Yang, Yu Dongliang, Peng Jinhua, Xu Jianjun, Wei Yiping
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Front Surg. 2022 May 6;9:893429. doi: 10.3389/fsurg.2022.893429. eCollection 2022.
With the development of surgical techniques and advances in systemic treatments, the survival time of esophageal cancer survivors has increased; however, the chance of developing a second primary malignancy (SPM) has also increased. These patients' prognosis and treatment plans remain inconclusive.
We aimed to evaluate and predict the survival of patients with esophageal cancer with second primary tumors, to provide insights and the latest data on whether to pursue more aggressive treatment.
We selected esophageal cancer cases from the latest available data from the SEER database on April 15, 2021. We performed life table analysis, Kaplan-Meier analysis, and univariate and multivariate Cox proportional hazards analysis to assess the patient data. We conducted multiple Cox regression equation analyses under multiple covariate adjustment models, and performed a stratified analysis of multiple Cox regression equation analysis based on different covariates. To describe our study population more simply and clearly, we defined the group of patients with esophageal cancer combined with a second primary malignant tumor (the first of two or more primaries) as the EC-SPM group.
Our analysis of 73,456 patients with esophageal cancer found the median survival time of the EC-SPM group was 47.00 months (95% confidence interval (CI), 43.87-50.13), and the mean survival time was 74.67 months (95% CI, 72.12-77.22). Kaplan-Meier curves of different esophageal cancer survivors showed that the survival of the EC-SPM group was significantly better than that of the other groups ( < 0.01). Univariate Cox regression analysis showed that compared with only one malignancy only group, the hazard ratio (HR) of the EC-SPM group was 0.95 (95% CI, 0.92-0.99; < 0.05). In the multivariate Cox regression analysis under different adjustment models, the EC-SPM group had a reduced risk of death compared with the one primary malignancy only group (HR < 1, < 0.05).
Survivors of esophageal cancer with a second primary malignant cancer have a better prognosis, but require more aggressive treatment. This study provided new evidence and new ideas for future research on the pathophysiological mechanism and treatment concepts of esophageal cancer combined with SPM.
随着外科技术的发展和全身治疗的进步，食管癌幸存者的生存时间有所延长；然而，发生第二原发性恶性肿瘤（SPM）的几率也增加了。这些患者的预后和治疗方案仍无定论。
我们旨在评估和预测患有第二原发性肿瘤的食管癌患者的生存情况，为是否采取更积极的治疗提供见解和最新数据。
我们从监测、流行病学与最终结果（SEER）数据库2021年4月15日的最新可用数据中选取食管癌病例。我们进行了寿命表分析、Kaplan-Meier分析以及单因素和多因素Cox比例风险分析以评估患者数据。我们在多个协变量调整模型下进行了多次Cox回归方程分析，并基于不同协变量对多次Cox回归方程分析进行了分层分析。为了更简单明了地描述我们的研究人群，我们将患有食管癌并伴有第二原发性恶性肿瘤（两个或多个原发性肿瘤中的第一个）的患者组定义为EC-SPM组。
我们对73456例食管癌患者的分析发现，EC-SPM组的中位生存时间为47.00个月（95%置信区间（CI），43.87 - 50.13），平均生存时间为74.67个月（95%CI，72.12 - 77.22）。不同食管癌幸存者的Kaplan-Meier曲线显示，EC-SPM组的生存率明显优于其他组（<0.01）。单因素Cox回归分析表明，与仅患有一种恶性肿瘤的组相比，EC-SPM组的风险比（HR）为0.95（95%CI，0.92 - 0.99；<0.05）。在不同调整模型下的多因素Cox回归分析中，与仅患有一种原发性恶性肿瘤的组相比，EC-SPM组的死亡风险降低（HR<1，<0.05）。
患有第二原发性恶性肿瘤的食管癌幸存者预后较好，但需要更积极的治疗。本研究为未来食管癌合并SPM的病理生理机制和治疗理念的研究提供了新证据和新思路。
