Establishment Of A Second Primary Cancer Prediction Model For Patients With Esophageal Adenocarcinoma And Squamous Cell Carcinoma

Background and 0bjectiveMultiple primary carcinoma(MPC)refers to the appearance of two or more primary tumors in one or more organs that occur simultaneously or sequentially in a patient.The pathogenesis of MPC is still unclear.The main influencing factors are: 1.Environmental carcinogenic factors: environmental and occupational exposure,etc;2.Body factors: smoking history,genetic history,immunodeficiency,etc;3.Secondary factors: history of radiotherapy and chemotherapy immunotherapy,etc.With the continuous development of human medical standards,the continuous improvement of comprehensive treatment of cancer,the survival time of cancer patients has been significantly extended.At the same time,the incidence and diagnosis rate of MPC also increased accordingly.Because MPC is very similar to the clinical symptoms of patients with recurrent metastasis,but the tumor types are different,the early diagnosis and timely treatment of MPC has practical significance for improving the survival rate and quality of life of patients.China is one of the countries with high incidence of esophageal carcinoma.According to the latest research data,the incidence of esophageal carcinoma in China has risen to the third place in all malignant tumors in 2015,and the mortality rate ranks fourth.Esophageal carcinoma has become a serious threat to people's healthy living standards,as one of the major diseases.According to the pathological type,esophageal carcinoma mainly includes esophageal squamous cell carcinoma and esophageal adenocarcinoma.The former is mainly distributed in developing countries,and the latter is mainly distributed in developed countries.Although the treatment level of esophageal carcinoma has been significantly improved with the development of medical level,due to its special biological characteristics,the current treatment effect of esophageal carcinoma is still not satisfactory,and the 5-year survival rate is about 15% to 25%.The key to the diagnosis and treatment of esophageal carcinoma is early diagnosis and treatment,and the second is standardized treatment.We attempt to establish a clinical predictive model of second primary cancer in patients with esophageal adenocarcinoma and squamous cell carcinoma and to explore the pathogenesis of second primary esophageal cancer.In today's multidisciplinary cancer treatment environment,we attempt to provide evidence for the early diagnosis and timely treatment of patients with esophageal second primary cancer.MethodWe used a proportional subdistribution hazards model to estimate second primary malignancy risks among patients with esophageal adenocarcinoma and squamous cell carcinoma.We validated models using a bootstrap cross-validation method and performed decision curve analysis to evaluate their clinical utility.ResultAge group and SEER historic stage were significantly associated with second primary malignancy risk after diagnosis of esophageal adenocarcinoma and squamous cell carcinoma.Saving positive lymph nodes and distant metastasis were significant factors in the adenocarcinoma group,and marital status,tumor location and chemotherapy were significant factors in the squamous cell carcinoma group.Calibration plots show good concordance between predicted and actual outcomes except in high-probability areas for the risk of a second primary malignancy in patients with esophageal squamous cell carcinoma.Discrimination performances of the Fine–Gray models were evaluated using c-indices,which were 0.691 and 0.662 for second primary malignancies in patients with esophageal adenocarcinoma and squamous cell carcinoma,respectively.Decision curve analysis yielded a range of threshold probabilities(0.020-0.177 and 0.021-0.133 for patients with esophageal adenocarcinoma and squamous cell carcinoma,respectively)at which the clinical net benefit of the risk model was larger than those of hypothetical all-screening and no-screening scenarios.ConclusionOur nomograms enable selection of patient populations at high risk for a second primary malignancy and thus will facilitate the design of prevention trials for affected populations.