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Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis

BACKGROUND: Second primary malignancy (SPM) is becoming a threat for the health of cancer survivors. However, data on the features and results of patients with hepatocellular carcinoma (HCC) with SPMs are scarce. This study aimed to explore the characteristics of HCC patients with SPMs and to screen...

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Autores principales: Kong, Junjie, Yu, Guangsheng, Si, Wei, Li, Guangbing, Chai, Jiawei, Liu, Yong, Liu, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420091/
https://www.ncbi.nlm.nih.gov/pubmed/34497765
http://dx.doi.org/10.3389/fonc.2021.713637
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author Kong, Junjie
Yu, Guangsheng
Si, Wei
Li, Guangbing
Chai, Jiawei
Liu, Yong
Liu, Jun
author_facet Kong, Junjie
Yu, Guangsheng
Si, Wei
Li, Guangbing
Chai, Jiawei
Liu, Yong
Liu, Jun
author_sort Kong, Junjie
collection PubMed
description BACKGROUND: Second primary malignancy (SPM) is becoming a threat for the health of cancer survivors. However, data on the features and results of patients with hepatocellular carcinoma (HCC) with SPMs are scarce. This study aimed to explore the characteristics of HCC patients with SPMs and to screen HCC patients who are at a high risk of developing SPMs. METHOD: HCC patients diagnosed between 2000 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Eligible patients were divided into the only one primary malignancy and SPM groups. The Fine-Gray proportional subdistribution hazards model was used to explore the risk factors of developing SPMs, and a competing-risk model was established to predict the probability of developing SPMs for HCC patients after initial diagnosis. The calibration curves, concordance index (C-index), and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS: A total of 40,314 HCC patients were identified, 1,593 (3.95%) of whom developed SPMs 2 months after the initial diagnosis with a maximum follow-up time of approximately 18 years. The 3-, 5-, and 10-year cumulative incidence of SPMs were 2.35%, 3.12%, and 4.51%, respectively. Age at initial diagnosis, extent of disease, tumor size, and treatment were identified as the independent risk factors of developing SPMs and integrated into the competing-risk nomogram. The C-index of the nomogram was 0.677 (95% confidence interval 0.676–0.678), and the calibration curves showed an excellent agreement between the nomogram prediction and the actual observations. Furthermore, DCA indicated that the nomogram had good net benefits in clinical scenarios. CONCLUSIONS: HCC survivors remain at a high risk of developing SPMs. The development of SPMs was associated with the clinical features and treatment strategies. A competing-risk nomogram was constructed to help surgeons identify the patients who are at a high risk of developing SPMs and contribute to the further management of SPMs.
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spelling pubmed-84200912021-09-07 Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis Kong, Junjie Yu, Guangsheng Si, Wei Li, Guangbing Chai, Jiawei Liu, Yong Liu, Jun Front Oncol Oncology BACKGROUND: Second primary malignancy (SPM) is becoming a threat for the health of cancer survivors. However, data on the features and results of patients with hepatocellular carcinoma (HCC) with SPMs are scarce. This study aimed to explore the characteristics of HCC patients with SPMs and to screen HCC patients who are at a high risk of developing SPMs. METHOD: HCC patients diagnosed between 2000 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Eligible patients were divided into the only one primary malignancy and SPM groups. The Fine-Gray proportional subdistribution hazards model was used to explore the risk factors of developing SPMs, and a competing-risk model was established to predict the probability of developing SPMs for HCC patients after initial diagnosis. The calibration curves, concordance index (C-index), and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS: A total of 40,314 HCC patients were identified, 1,593 (3.95%) of whom developed SPMs 2 months after the initial diagnosis with a maximum follow-up time of approximately 18 years. The 3-, 5-, and 10-year cumulative incidence of SPMs were 2.35%, 3.12%, and 4.51%, respectively. Age at initial diagnosis, extent of disease, tumor size, and treatment were identified as the independent risk factors of developing SPMs and integrated into the competing-risk nomogram. The C-index of the nomogram was 0.677 (95% confidence interval 0.676–0.678), and the calibration curves showed an excellent agreement between the nomogram prediction and the actual observations. Furthermore, DCA indicated that the nomogram had good net benefits in clinical scenarios. CONCLUSIONS: HCC survivors remain at a high risk of developing SPMs. The development of SPMs was associated with the clinical features and treatment strategies. A competing-risk nomogram was constructed to help surgeons identify the patients who are at a high risk of developing SPMs and contribute to the further management of SPMs. Frontiers Media S.A. 2021-08-23 /pmc/articles/PMC8420091/ /pubmed/34497765 http://dx.doi.org/10.3389/fonc.2021.713637 Text en Copyright © 2021 Kong, Yu, Si, Li, Chai, Liu and Liu https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Kong, Junjie
Yu, Guangsheng
Si, Wei
Li, Guangbing
Chai, Jiawei
Liu, Yong
Liu, Jun
Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title_full Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title_fullStr Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title_full_unstemmed Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title_short Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis
title_sort second primary malignancies in patients with hepatocellular carcinoma: a population-based analysis
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420091/
https://www.ncbi.nlm.nih.gov/pubmed/34497765
http://dx.doi.org/10.3389/fonc.2021.713637
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