Guo Qian Qian, Ma Shi Zhou, Zhao De Yao, Beeraka Narasimha M, Gu Hao, Zheng Yu Fei, Zhao Rui Wen, Li Si Ting, Nikolenko Vladimir N, Bulygin Kirill V, Basappa Basappa, Fan Rui Tai, Liu Jun Qi
Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China.
Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China.
World J Oncol. 2024 Aug;15(4):598-611. doi: 10.14740/wjon1834. Epub 2024 Jun 18.
Impact of radiotherapy (RT) for esophageal cancer (EC) patients on the development of secondary head and neck cancer (SHNC) remains equivocal. The objective of this study was to investigate the link between definitive RT used for EC treatment and subsequent SHNC.
This study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of primary EC patients. Fine-Gray competing risk regression and standardized incidence ratio (SIR) and propensity score matching (PSM) method were used to match SHNC patients with only primary head and neck cancer (HNC) patients. Overall survival (OS) rates were applied by Kaplan-Meier analysis.
In total, 14,158 EC patients from the SEER database were included, of which 9,239 patients (65.3%) received RT and 4,919 patients (34.7%) received no radiation therapy (NRT). After a 12-month latency period, 110 patients (1.2%) in the RT group and 36 patients (0.7%) in the NRT group experienced the development of SHNC. In individuals with primary EC, there was an increased incidence of SHNC compared to the general US population (SIR = 5.95, 95% confidence interval (CI): 5.15 - 6.84). Specifically, the SIR for SHNC was 8.04 (95% CI: 6.78 - 9.47) in the RT group and 3.51 (95% CI: 2.64 - 4.58) in the NRT group. Patients who developed SHNC after RT exhibited significantly lower OS compared to those after NRT. Following PSM, the OS of patients who developed SHNC after RT remained significantly lower than that of matched patients with only primary HNC.
An association was discovered between RT for EC and increased long-term risk of SHNC. This work enables radiation oncologists to implement mitigation strategies to reduce the long-term risk of SHNC in patients who have received RT following primary EC.
放射治疗（RT）对食管癌（EC）患者继发性头颈癌（SHNC）发生发展的影响仍不明确。本研究的目的是调查用于EC治疗的根治性RT与随后发生的SHNC之间的联系。
本研究使用监测、流行病学和最终结果（SEER）数据库收集原发性EC患者的数据。采用Fine-Gray竞争风险回归、标准化发病率比（SIR）和倾向评分匹配（PSM）方法将SHNC患者与仅患有原发性头颈癌（HNC）的患者进行匹配。通过Kaplan-Meier分析计算总生存率（OS）。
SEER数据库共纳入14158例EC患者，其中9239例（65.3%）接受了RT，4919例（34.7%）未接受放射治疗（NRT）。经过12个月的潜伏期，RT组有110例患者（1.2%）发生了SHNC，NRT组有36例患者（0.7%）发生了SHNC。与美国普通人群相比，原发性EC患者中SHNC的发病率有所增加（SIR = 5.95，95%置信区间（CI）：5.15 - 6.84）。具体而言，RT组SHNC的SIR为8.04（95%CI：6.78 - 9.47），NRT组为3.51（95%CI：2.64 - 4.58）。RT后发生SHNC的患者的OS显著低于NRT后发生SHNC的患者。PSM后，RT后发生SHNC的患者的OS仍显著低于仅患有原发性HNC的匹配患者。
发现EC的RT与SHNC的长期风险增加之间存在关联。这项工作使放射肿瘤学家能够实施缓解策略，以降低原发性EC后接受RT的患者发生SHNC的长期风险。
