Survival analysis of second primary malignancies after cervical cancer using a competing risk model: implications for prevention and surveillance

Abstract

Background: Previous studies have reported an increased risk for second primary malignancies (SPMs) after cervical cancer (CC). This study aims to quantify and assess the risk of developing SPMs in long-term survivors of CC.Methods: A population-based cohort of CC patients aged 20-79 years was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk model and corresponding nomogram were constructed to predict the 3-, 5-, and 10-year cumulative risks of SPMs. A Fine-Gray plot was created to validate the model. Finally, we performed decision curve analysis (DCA) to evaluate the clinical usefulness of the model by calculating the net benefit.Results: A total of 34,295 patients were identified, and approximately 6.3% of the study participants developed SPMs. According to the multivariable competing-risk model, older black CC survivors with localized disease who were treated with radiation therapy were more susceptible to SPMs. The 3-, 5-, and 10-year cumulative incidences of SPMs were 2.5%, 3.6%, and 6.2%, respectively. Calibration curves showed good agreement between the predicted and observed models. The DCA yielded a wide range of risk thresholds at which the net benefits could be obtained from our proposed model. Conclusions:This study provides physicians with a practical, individualized prognostic estimate to assess the risk of SPMs among CC survivors. CC survivors remain at a high risk of developing SPMs, and further surveillance should focus especially on the patients with black race, older age, localized disease, or those having received radiation therapy.

Second Primary Malignancy in Patients with Hypopharyngeal Carcinoma: A SEER-Based Study

“… 36 Patients with cervical cancer with SPM have been found to experience better OS within 6 years than those without SPM. 38 However, this result may be inconsistent with clinical observations. The first possible reason for this discrepancy is that HPC might have a shorter survival time than other types of SPM tumors; the second is that the follow-up time might not have been long enough.…”

Development and validation of a competing risk model for second primary pancreatic ductal adenocarcinoma: A population-based study

“…Therefore, in competing risk events, the Fine and Gray proportional sub-distributed hazard method is advocated ( 56 , 57 ). To the best of our knowledge, researchers have used the Fine and Gray proportional subdistributed hazard method to construct competing risk models for multiple primary cancers associated with cervical cancer ( 58 ) and colorectal cancer ( 59 ). However, competing risk models for spPDAC cancer-specific mortality have not yet emerged.…”

A Bayesian network predicting survival of cervical cancer patients—Based on surveillance, epidemiology, and end results

“…So far, there has been no consensus on the role of black ethnicity in poorer survival of cervical cancer, 24 , 25 , 26 , 27 , 28 , 29 even after controlling for treatment patterns. 30 , 31 In this study, we selected patients who underwent at least one type of radiation therapy or surgery, but we still found that being black was associated with poorer overall survival, and being Asian was a protective factor.…”