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Risk Assessment of Secondary Primary Malignancies in Nasopharyngeal Carcinoma: A Big-Data Intelligence Platform-Based Analysis of 6,377 Long-term Survivors from an Endemic Area Treated with Intensity-Modulated Radiation Therapy during 2003-2013
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Lu-Lu Zhang, Guo-Hong Li, Yi-Yang Li, Zhen-Yu Qi, Ai-Hua Lin, Ying Sun
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Cancer Res Treat. 2019;51(3):982-991. Published online October 11, 2018
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DOI: https://doi.org/10.4143/crt.2018.298
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 Abstract
 PDF PubReader ePub
- Purpose
The incidence, risk factors and survival impact of secondary primary malignancies (SPMs) among survivors of nasopharyngeal carcinoma (NPC) treated with definitive intensity-modulated radiation therapy (IMRT) with or without chemotherapy are poorly characterized.
Methods
and Materials
Consecutive patients (n=6,377) from the big-data intelligence platform at Sun Yat-sen University Cancer Center, China (in a high-incidence area) with newly diagnosed non-metastatic pathologically proven non-keratinizing undifferentiated NPC treated with IMRT±chemotherapy between January 2003 and June 2013 were retrospectively analyzed. Cumulative incidence of SPMs was calculated using the Kaplan-Meier method. Cox proportional hazards model was used to identify potential risk factors for SPMs and assess whether SPMs affect overall survival.
Results
Of the 6,377 patients, 189 (3.0%) suffered SPMs (median follow-up, 62 months). One-, 2-, 3-, 4-, and 5-cumulative risks of SPMs were 0.4%, 0.9%, 1.6%, 2.2%, and 2.6%, respectively. Latency from start of IMRT to SPMs diagnosis was 37 months (range, 6 to 102 months). In patients with SPMs, 14.3% suffered SPMs within 1 year post-IMRT: 1-3 years, 38.1%; 3-5 years, 33.9%; and >5 years, 13.7%. Lung cancer was the most common SPM (50/6,377, 0.78%). Multivariate analysis demonstrated sex (male, 64% increase), age (≥50 years, 68% increase), and smoking history (41% increase) were significant risk factors for SPMs, and SPMs were associated with poorer overall survival.
Conclusion
This large cohort study confirms SPMs a dreadful complication for long-term survivors of NPC treated with IMRT. SPMs negatively impact overall survival in NPC. Close follow-up is recommended for older male survivors with a smoking history.
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Citations
Citations to this article as recorded by  - Age-specific characteristics of head and neck second primary malignancies in patients treated for nasopharyngeal carcinoma: a retrospective study
Q. Jiang, T. Xu, M. Zeng, Y. He, Y. Cai, Z. Huang
International Journal of Oral and Maxillofacial Surgery.2024; 53(1): 11. CrossRef - The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma
Peter K. M. Ku, Alexander C. Vlantis, Thomas S. C. Hui, Zenon W. C. Yeung, Ryan H. W. Cho, Marc H. K. Wong, Alex K. F. Lee, David C. M. Yeung, Simon Y. P. Chan, Becky Y. T. Chan, Wai‐tsz Chang, Florence Mok, Kam‐hung Wong, Jeffrey K. T. Wong, Victor Abdul
Head & Neck.2024; 46(7): 1637. CrossRef - Maxillary sinus anterior wall recurrence after intensity-modulated radiotherapy for nasopharyngeal carcinoma
Y Fang, L Wang, X Chen, C Cao
International Journal of Radiation Research.2024; 22(3): 803. CrossRef - Detection and staging of recurrent or metastatic nasopharyngeal carcinoma in the era of FDG PET/MR
Yongfeng Piao, Caineng Cao, Yuanfan Xu, Shuang Huang, Feng Jiang, Ting Jin, Qifeng Jin, Yonghong Hua, Qiaoying Hu, Xiaozhong Chen
European Archives of Oto-Rhino-Laryngology.2022; 279(1): 353. CrossRef - Second Primary Lung Adenocarcinoma After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma
Fen Xue, Xiaoshuang Niu, Chaosu Hu, Xiayun He
Frontiers in Oncology.2022;[Epub] CrossRef - Racial and ethnic disparities in nasopharyngeal cancer with an emphasis among Asian Americans
Qian Wang, Hui Xie, Yannan Li, Nicholas Theodoropoulos, Yaning Zhang, Changchuan Jiang, Chi Wen, Laura S. Rozek, Paolo Boffetta
International Journal of Cancer.2022; 151(8): 1291. CrossRef - Factors associated with the development of second primary tumours in head and neck cancer patients
Inmaculada Salcedo‐Bellido, Pilar Requena, Rocío Mateos, Carmen Ortega‐Rico, Rocío Olmedo‐Requena, Macarena Lozano‐Lorca, Juan Pedro Arrebola, Rocío Barrios‐Rodríguez
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Kenneth C. W. Wong, Edwin P. Hui, Kwok-Wai Lo, Wai Kei Jacky Lam, David Johnson, Lili Li, Qian Tao, Kwan Chee Allen Chan, Ka-Fai To, Ann D. King, Brigette B. Y. Ma, Anthony T. C. Chan
Nature Reviews Clinical Oncology.2021; 18(11): 679. CrossRef - The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma
Ling‐Long Tang, Yu‐Pei Chen, Chuan‐Ben Chen, Ming‐Yuan Chen, Nian‐Yong Chen, Xiao‐Zhong Chen, Xiao‐Jing Du, Wen‐Feng Fang, Mei Feng, Jin Gao, Fei Han, Xia He, Chao‐Su Hu, De‐sheng Hu, Guang‐Yuan Hu, Hao Jiang, Wei Jiang, Feng Jin, Jin‐Yi Lang, Jin‐Gao Li,
Cancer Communications.2021; 41(11): 1195. CrossRef - Radiation-induced second primary squamous cell carcinoma of the oral cavity after radiotherapy for nasopharyngeal carcinoma
Chao Liu, Lieqiang Liao, Guoying Wu, Honghong Yan, Xiaoqi Chen, Chao Wang, Xiajing Zheng, Ziyi Zeng, Zheng Zhao, Di Wu, Xuekui Liu
Oral Oncology.2020; 109: 104863. CrossRef - Second primary cancer after intensity-modulated radiotherapy for nasopharyngeal carcinoma: A territory-wide study by HKNPCSG
James C.H. Chow, Anthony H.P. Tam, Ka-Man Cheung, Victor H.F. Lee, Chi-Leung Chiang, Macy Tong, Edwin C.Y. Wong, Alice K.W. Cheung, Sunny P.C. Chan, Jessica W.Y. Lai, Roger K.C. Ngan, Wai-Tong Ng, Anne W.M. Lee, Kwok-Hung Au
Oral Oncology.2020; 111: 105012. CrossRef
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Proposal of a Pretreatment Nomogram for Predicting Local Recurrence after Intensity-Modulated Radiation Therapy in T4 Nasopharyngeal Carcinoma: A Retrospective Review of 415 Chinese Patients
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Lu-Lu Zhang, Yi-Yang Li, Jiang Hu, Guan-Qun Zhou, Lei Chen, Wen-Fei Li, Ai-Hua Lin, Jun Ma, Zhen-Yu Qi, Ying Sun
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Cancer Res Treat. 2018;50(4):1084-1095. Published online November 15, 2017
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DOI: https://doi.org/10.4143/crt.2017.359
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Abstract
PDFPubReaderePub
- Purpose
Local relapse-free survival (LRFS) differs widely among patients with T4 category nasopharyngeal carcinoma (NPC). We aimed to build a nomogram incorporating clinicopathological information to predict LRFS in T4 NPC after definitive intensity-modulated radiation therapy (IMRT).
Materials and Methods
Retrospective study of 415 Chinese patients with non-metastatic T4 NPC treated with definitive IMRT with or without chemotherapy at our cancer center between October 2009 and September 2013. The nomogram for LRFS at 3 and 5 years was generated based on multivariate Cox proportional hazards regression, and validated using bootstrap resampling, assessing discriminative performance using the concordance index (C-index) and determining calibration ability via calibration curves.
Results
Five-year LRFS was 88.8%. We identified and incorporated four independent prognostic factors for LRFS: ethmoid sinus invasion, primary gross tumor volume, age, and pretreatment body mass index. The C-index of the nomogram for local recurrence was 0.732 (95% confidence interval, 0.726 to 0.738), indicating excellent predictive accuracy. The calibration curve revealed excellent agreement between nomogram-predicted and observed LRFS probabilities. Risk subgroups based on total point score cutoff values enabled effective discrimination of LRFS.
Conclusion
This pretreatment nomogram enables clinicians to accurately predict LRFS in T4 NPC after definitive IMRT, and could help to facilitate personalized patient counselling and treatment strategies.
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Citations
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