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Analysis of chemotherapy effect on the second primary malignancy for head and neck cancer patients by a nomogram based on SEER database.

ABSTRACT: Second primary malignancy (SPM) ranks the second leading cause of death in patients with head and neck cancer (HNC), while studies exploring the risk factors for SPM are limited. To clarify this, we investigated the relationship between the chemotherapy and SPM using the Surveillance, Epidemiology, and End Results (SEER) database. 11 345 patients initially diagnosed with HNC between 1998 and 2016 were selected from the SEER database. First, these patients were divided into two groups according to chemotherapy or not. With Fine and Gray model, the subdistribution hazard ratio (sHR) of chemotherapy was calculated based on Propensity Score Matching (PSM). Second, the 11 345 cases were randomized into a training set and a validation set. Based on the training set, the different cumulative incidence of SPMs between the patients with and without chemotherapy was estimated respectively in the high- and low-risk group according to the scores derived from a nomogram. Chemotherapy was negatively correlated to the SPMs (sHR: 0.847, 95% CI: 0.733-0.977, P = .023) by conducting competing risk analysis. With chemotherapy, forest plots showed subgroups of squamous cell carcinoma (SCC, sHR: 0.815, 95% CI: 0.7-0.948, P = .008), 50-64 years old (sHR:0.794, 95% CI: 0.655-0.962, P = .019), male (sHR:0.828, 95% CI: 0.703-0.974, P = .023), and well/moderate histological grade (sHR:0.828, 95% CI: 0.688-0.996, P = .045) were negatively correlated to SPMs; the nomogram showed the high-risk population characterized as SCC, elder age, male, and well/moderate histological grade also tended to have lower incidence of SPMs (sHR: 0.805, 95% CI: 0.669-0.969, P = .022). Despite HNC patients with characteristics of SCC, increased age, male, and well/moderate histological grade had higher risk of a SPM, they were also more likely to be benefitted from chemotherapy to avoid it.

SUBMITTER: Li X

PROVIDER: S-EPMC7643691 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Analysis of chemotherapy effect on the second primary malignancy for head and neck cancer patients by a nomogram based on SEER database.

Li Xinrong X Guo Kaibo K Feng Yuqian Y Guo Yong Y

Cancer medicine 20200915 21

Second primary malignancy (SPM) ranks the second leading cause of death in patients with head and neck cancer (HNC), while studies exploring the risk factors for SPM are limited. To clarify this, we investigated the relationship between the chemotherapy and SPM using the Surveillance, Epidemiology, and End Results (SEER) database. 11 345 patients initially diagnosed with HNC between 1998 and 2016 were selected from the SEER database. First, these patients were divided into two groups according t ...[more]

PMID: 32931661

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Project description:BACKGROUND:p14(ARF) , an alternate reading frame (ARF) product of the cyclin-dependent kinase inhibitor 2A locus, plays a critical role in crosstalk between the tumor protein 53 (p53) and retinoblastoma (Rb) pathways and in cellular anticancer mechanisms. Therefore, the authors of this report investigated the association between single nucleotide polymorphisms (SNPs) of the p14(ARF) gene and the risk of developing a second primary malignancy (SPM) after an index squamous cell carcinoma of the head and neck (SCCHN). METHODS:The log-rank test and Cox proportional hazards models were used to assess the association of 2 p14(ARF) SNPs (reference SNP [rs]3731217 and rs3088440) with SPM-free survival and with the risk of developing an SPM among 1287 patients who had SCCHN. RESULTS:Patients with either p14(ARF) variant genotypes of the 2 polymorphisms had a significantly reduced SPM-free survival compared with patients with no variant genotypes (log-rank test; P = .006). Compared with the p14(ARF) thymine-thymine (TT) and guanine-guanine (GG) genotypes, the variant genotypes of p14(ARF) TG/GG and guanine-adenine (GA)/AA were associated with a significantly moderately increased risk of developing an SPM (p14(ARF) rs3731217: adjusted hazard ratio [aHR], 1.48; 95% confidence interval [CI], 1.00-2.19; p14(ARF) rs3088440: aHR, 1.61; 95% CI, 1.07-2.43). Moreover, after combining the variant genotypes of the 2 SNPs, patients who had variant genotypes were at significantly greater risk of developing an SPM compared with patients who had no variant genotypes (aHR, 3.07; 95% CI, 1.54-6.12), and the risk was particularly pronounced in several subgroups. CONCLUSIONS:The current results suggested that there is a modestly increased risk of developing an SPM after an index SCCHN with each p14(ARF) polymorphism, and there is an even greater risk of developing an SPM for patients with combined variant genotypes of the 2 SNPs. Therefore, p14(ARF) polymorphisms may be susceptible markers of the risk of developing an SPM in patients with SCCHN.

Project description:Background: Bone metastasis (BM) is one of the typical metastatic types of head and neck cancer (HNC). The occurrence of BM prevents the HNC patients from obtaining a long survival period. Early assessment of the possibility of BM could bring more therapy options for HNC patients, as well as a longer overall survival time. This study aims to identify independent BM risk factors and develop a diagnostic nomogram to predict BM risk in HNC patients. Methods: Patients diagnosed with HNC between 2010 and 2015 were retrospectively evaluated in the Surveillance, Epidemiology, and End Results (SEER) database, and then eligible patients were enrolled in our study. First, those patients were randomly assigned to training and validation sets in a 7:3 ratio. Second, univariate and multivariate logistic regression analyses were used to determine the HNC patients' independent BM risk factors. Finally, the diagnostic nomogram's risk prediction capacity and clinical application value were assessed using calibration curves, receiver operating characteristic (ROC), and decision curve analysis (DCA) curves. Results: 39,561 HNC patients were enrolled in the study, and they were randomly divided into two sets: training (n = 27,693) and validation (n = 11,868). According to multivariate logistic regression analysis, race, primary site, tumor grade, T stage, N stage, and distant metastases (brain, liver, and lung) were all independent risk predictors of BM in HNC patients. The diagnostic nomogram was created using the above independent risk factors and had a high predictive capacity. The training and validation sets' area under the curves (AUC) were 0.893 and 0.850, respectively. The AUC values of independent risk predictors were all smaller than that of the constructed diagnostic nomogram. Meanwhile, the calibration curve and DCA also proved the reliability and accuracy of the diagnostic nomogram. Conclusion: The diagnostic nomogram can quickly assess the probability of BM in HNC patients, help doctors allocate medical resources more reasonably, and achieve personalized management, especially for HNC patients with a potentially high BM risk, thus acquiring better early education, early detection, and early diagnosis and treatment to maximize the benefits of patients.

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Analysis of chemotherapy effect on the second primary malignancy for head and neck cancer patients by a nomogram based on SEER database.

Publications

Analysis of chemotherapy effect on the second primary malignancy for head and neck cancer patients by a nomogram based on SEER database.

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