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Survival outcomes from the onset of cervical cancer according to age at cervical cancer onset (age < 50 years vs. age ≥ 50 years) in all women with cervical cancer (A) and in women with a second primary cancer (B).
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s This study was conducted to investigate the incidence and survival outcomes of second primary cancers after the diagnosis of cervical cancer.
Data from the Korea Central Cancer Registry between 1993 and 2010 were reviewed and analyzed. Standardized incidence ratios (SIRs) of second primary cancers among women with cervical cancer were analyzed. K...
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Context 1
... 5-year and 10-year overall survival rates from the onset of cervical cancer (Fig. 1A) were 78.3% and 72.7% in all women with cervical cancer, respectively. Among all women, significantly higher survival was observed in patients aged < 50 years (p < 0.001); the 5-year and 10-year overall survival rates were 86.8% and 84.4% for women aged < 50 years and 78.3% and 61.2% for women aged ≥ 50 years, respectively. For women with a second primary cancer, the 5-year and 10-year overall survival rates (Fig. 1B) were 83.2% and 65.5%, respectively. In these women, significantly higher survival was observed in patients aged < 50 years (p < 0.001), and the 5-year and 10-year overall survival rates were 88.6% and 76.8% for women aged < 50 years and 83.2% and 57.8% for women aged ≥ 50 years, respectively. A higher 5-year overall survival rate was observed in patients with a second primary cancer, but the 10-year overall survival rate was lower in patients with a second primary cancer (p < ...
Context 2
... 5-year and 10-year overall survival rates from the onset of cervical cancer (Fig. 1A) were 78.3% and 72.7% in all women with cervical cancer, respectively. Among all women, significantly higher survival was observed in patients aged < 50 years (p < 0.001); the 5-year and 10-year overall survival rates were 86.8% and 84.4% for women aged < 50 years and 78.3% and 61.2% for women aged ≥ 50 years, respectively. For women with a second primary cancer, the 5-year and 10-year overall survival rates (Fig. 1B) were 83.2% and 65.5%, respectively. In these women, significantly higher survival was observed in patients aged < 50 years (p < 0.001), and the 5-year and 10-year overall survival rates were 88.6% and 76.8% for women aged < 50 years and 83.2% and 57.8% for women aged ≥ 50 years, respectively. A higher 5-year overall survival rate was observed in patients with a second primary cancer, but the 10-year overall survival rate was lower in patients with a second primary cancer (p < ...
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Background: The population-based Cancer Registry of Cali Colombia operates continuously since 1962, disseminating incidence information in the XI volumes of Cancer Incidence in Five Continents.
Aim: To describe the incidence and mortality rates for the period 2011-2020 and the changes in the trend of incidence rates (1962-2017) and mortality rates...
Citations
... However, most cancer survivors could face the risk of developing SPMs, due to long-term side effects of chemotherapy and/or radiation therapy and persisting effects of genetic and behavioral risk factors (Copur and Manapuram, 2019). Population-based study has pointed out that CC survivors were at great risk of developing SPMs (Lim et al., 2016), and they were even more likely to die from their SPMs than the initial cancers (Donin et al., 2016). So far, few studies have evaluated the differences on prognosis and therapeutic benefits between first primary CC and second primary CC using a nationwide database. ...
To explore the characteristics, influencing factors, and effect of different treatments on the survival in patients with first primary cervical cancer (CC) and second primary CC. Data of 33,934 eligible patients with CC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in 2004–2015. We also included 176 patients with CC from the Affiliated Dongyang Hospital of Wenzhou Medical University. Univariate and multivariate Cox proportional hazard models were used to screen the potential influencing factors associated with the survival in patients with hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses of age, American Joint Committee on Cancer (AJCC) stages, tumor grades and histologic types were conducted to explore the association between different treatments and survival in different populations. The 5-year mortality was 43.08 % for patients with first primary CC and that was 58.13 % for patients with second primary CC. We found that the relationships between age, histologic type, tumor grade, tumor size, AJCC tumor-node-metastasis (TNM) stage, surgery, chemotherapy, radiotherapy and the first primary CC and second primary CC were different (all P < 0.05). Additionally, the results of subgroup analyses indicated that the choice of surgery, chemotherapy, and radiotherapy should be adjusted according to the different health conditions of the patients. In conclusion, the causal relationship between characteristics, influencing factors, and treatments and survival in patients with primary CC diagnosed as different time periods are needed further exploration.
... Netherlands retrospective study also found an 80% increased SPMs risk in CC survivors contrasted to the general population (Arnold et al. 2014). A study from Korea (Lim et al. 2016) found that the 10-year overall survival (OS) for CCSPM patients was worse than CC patients without SPMs (65.5% vs. 73.1%). So, estimating SPMs risk and seeking active measures to minimize the threat has been the focus of research in recent years. ...
... As a "side effect," it also has increased the risk of SPMs. Approximately 5.78%-6.4% of cancer patients have a history of multiple cancers, and the rate is uprising (Chen et al. 2012;Lim et al. 2016). Most CC patients are unconcerned about SPMs and only undergo further examination after symptoms are obvious. ...
... Most CC patients are unconcerned about SPMs and only undergo further examination after symptoms are obvious. Consequently, the survival rate decreased significantly (Lim et al. 2016). It is meaningful to timely assess the risk probability of SPMs Content courtesy of Springer Nature, terms of use apply. ...
Purpose
Cervical cancer (CC) patients are more likely to develop second primary malignancies (SPMs) than general population. With the advancement in cancer therapy, CC patients are achieving long-term survival, leading SPMs to our attention. Our study aims to establish diagnostic and prognostic nomograms for CC patients with second primary malignancies (CCSPMs) to help make personalized follow-up plans and treatments.
Methods
Data of CCSPMs between 2000 and 2019 was extracted from SEER. The proportions and the median interval time of CCSPM onset were calculated. 11 related clinical characteristics, including age, race, marital status, grade, FIGO stage, radiotherapy, chemotherapy, and surgery, were further explore. Logistic and Cox regressions were employed to predict risk factors for CCSPMs diagnosis. Finally, two nomograms were developed to predict the probability occurrence and prognosis of CCSPMs, respectively.
Results
For diagnostic nomogram construction, 59,178 CC patients were randomly divided into training (n = 41,426) and validation cohorts (n = 17,752). For prognostic nomogram construction, 3527 CCSPMs patients were randomly divided into training (n = 2469) and validation cohorts (n = 1058). The diagnostic nomogram consisting of above 11 independent risk factors (all P < 0.05), had high accuracy (AUCtraining = 0.851 and AUCvalidating = 0.845). The prognostic nomogram integrated with eight independent prognostic factors such as treatments, FIGO stage and TNM stage performed well in predicting 5-year OS (AUCtraining = 0.835 and AUCvalidating = 0.837).
Conclusion
Our diagnostic and prognostic nomograms could facilitate clinicians to quantify individual SPMs risk and survival probabilities and optimize the surveillance recommendations and personalized clinical decision-making.
... However, with the growing number of cervical cancer survivors, primary second cancers in these patients pose a new challenge [10]. Compared to the general population, there is an increased incidence of a second primary malignancy in patients diagnosed and treated for cervical cancer [11]. The development of subsequent malignancies is typically related to shared risk factors between primary and secondary cancers. ...
Objective
This study aims to determine the common second malignancies among patients with primary cervical cancers and the factors associated with improved overall survival.
Methodology
We conducted a retrospective analysis of all PCCs in the SEER database between 1975 and 2016. We identified a subset of patients who subsequently developed secondary malignancies after a primary cervical cancer diagnosis. We then determined the factors associated with a prolonged latency interval, defined as the time between the PCC diagnosis and a subsequent secondary malignancy diagnosis. In a sub-analysis, we also determined the commonest secondary malignancies following a PCC diagnosis.
Results
A total of 1,494 patients with cervical cancers developed a second malignancy during the study period. The mean age at diagnosis of the PCCs was 56.0 ± 14.0 years. The mean latency interval between PCC and a subsequent secondary malignancy was 9.6 ± 9.3 years. Cytoreductive surgery (odds ratio (OR) = 1.40; 95% confidence interval (CI) = 1.05-1.86) and radiotherapy (OR = 1.52; 95% CI = 1.14-2.03) during the PCC are associated with a prolonged latency interval.
Patients who received chemotherapy (OR = 0.23; 95% CI = 0.16-0.33) or those of Hispanic ethnicity (OR = 0.63; 95% CI = 0.44-0.90) were more likely to develop second malignancies within 10 years after a PCC diagnosis. The most common second malignancies were abdominal malignancies with rectal cancers (12.2%), pancreatic cancers (10.1%), stomach cancers (9.2%), cecum cancers (8.4%), and sigmoid colon cancers (8.3%).
Conclusion
There is a significant association between Hispanic ethnicity and a shorter latency interval among patients with PCC. The findings from this study may help optimize screening for secondary cancers among cervical cancer survivors.
... Oropharyngeal cancers (tongue, tonsil, oropharynx) [18] and cancers of the vagina, vulva, anus, and rectum were usually associated with HPV infection and were used as proxies of HPV-related SPMs. Cancers of the esophagus, lung, bronchus, and bladder were classified as potentially smoking-related SPMs [18,19]. In addition, female breast and ovarian cancers were grouped as potentially hormone-related SPMs to compare cervical and endometrial cancer survivors [20]. ...
... Notably, radiotherapy of the pelvis can result in ovarian insufficiency since ovarian tissue is sensitive to radiation [29]. There was decreased breast SPM risk (SIR = 0.68, 95% CI: 0.56-0.82) in cervical cancer survivors, possibly due to alterations in hormone levels in the breast tissue following hysterectomy, ovariectomy, and premature ovarian failure resulting from radiation [19,30]. Sensitivity analyses were conducted for survivors who received hysterectomy and/or ovariectomy, and no significant difference was observed. ...
... However, none of these factors alone can fully explain the differences in potential SPM risk between cervical and endometrial cancer survivors. Recent studies have shown that risk factors associated with SPMs can jointly interact [19,31]. There were potentially strong synergistic interactions between RT and smoking (P < 0.01) in cervical cancer survivors in this study. ...
Background:
We evaluated the relative attribution and interactions of treatment and patient-related risk factors for second primary malignancies (SPMs) in cervical and endometrial cancer survivors.
Methods:
Stage I-III cervical and endometrial cancer survivors' data from the Surveillance, Epidemiology, and End Results (SEER) registry between January 1988 and December 2015 were analyzed. The standardized incidence ratio (SIR), excess absolute risk (EAR), and corresponding 95% confidence interval (95% CI) values were calculated. Analyses were classified based on proxies of human papillomavirus (HPV), smoking, hormone, and radiotherapy (RT) status. Additive and multiplicative interactions were assessed.
Results:
Cervical cancer survivors had a higher risk for developing potentially HPV and smoking-related SPMs, especially in the RT group (SIRHPV = 3.7, 95% CI: 2.9-4.6; SIRsmoking = 3.2, 95% CI: 2.8-3.6). Second vaginal cancer patients had the highest SIR (23.8, 95% CI: 14.9-36.0). There were strong synergistic interactions between RT and the proxy of smoking (Pinteraction < 0.001), accounting for 36% of potentially smoking-related SPMs in cervical cancer survivors.
Conclusions:
RT, HPV, and smoking promote SPMs in cervical cancer to different extents. The SPM burden in cervical cancer survivors could be mostly attributed to smoking and RT and their interactions.
... About 10% of all cancers originate from benign tumors in this organ; 1.09 million people were affected and 551, 000 people died of the disease in 2018. Developed countries are at the forefront of this disease [3,4,5]. According to the America Cancer Society, there were 51,020 cases of death and 145,600 newly-diagnosed CRC patients in 2019 [1]. ...
MicroRNAs play a crucial role in tumorigenesis, tumor progression, and metastasis, and thus they contribute in development of different malignancies including cervical cancer (CC) and colorectal cancer (CRC). Through integrated strategies of computational biology, this study aims to identify prognostic biomarkers responsible for CRC and CC prognosis, and potential therapeutic agents to halt the progression of these cancers. Expression analysis of miRNA datasets of CRC and CC identified 17 differentially expressed miRNAs (DEMs). SYNPO2, NEGR1, FGF7, LIFR, RUNX1T1, CFL2, BNC2, EPHB2, PMAIP1, and CDC25A differentially expressed genes (DEGs) regulated by these DEMs were classified as candidate genes responsible for CRC and CC. Down-regulation of Synaptopodin-2 (SYNPO2) is involved in emergence and progression of these cancers by activating ER, PI3K/AKT, and EMT pathways as well as by suppressing DNA damage response, and cell cycle pathways. Higher methylation rate in promoter region of SYNPO2 could be a possible reason for lowering the expression of SYNPO2 in tumor stages. Hence, the lower expression of SYNPO2 is associated with poor prognosis of CRC and CC and could function as prognostic biomarker and therapeutic target. Fourteen transcription factors were recognized which can activate/inhibit the transcription of SYNPO2 and may be a potential target to regulate expression of SYNPO2 in CRC and CC. Retinoic acid and Estradiol were identified as putative therapeutic drugs for CRC and CC patients. This study will thus help in understanding the underlying molecular events in CRC and CC that may improve the detection of malignant lesions in primary screening and will broaden the clinical applications.
... Cervical cancer is a common gynecological malignant tumor; it is the second most common malignant tumor in women after breast cancer [1]. Although research on cervical cancer has made great breakthroughs, it is still a risk factor for serious adverse effects on the physical and mental health of women [2]. At present, the treatment of cervical cancer is mainly based on the stage and patient age, and comprehensive treatment, including surgery, radiotherapy, chemotherapy, vaccine, and other methods, is commonly applied [1,2]. ...
... Although research on cervical cancer has made great breakthroughs, it is still a risk factor for serious adverse effects on the physical and mental health of women [2]. At present, the treatment of cervical cancer is mainly based on the stage and patient age, and comprehensive treatment, including surgery, radiotherapy, chemotherapy, vaccine, and other methods, is commonly applied [1,2]. For example, in the chemotherapy scheme of cervical cancer, combined chemotherapy based on cisplatin is mostly used [3]. ...
Background
Previous studies have shown that miR-21 upregulation is related to the aggressive development of cervical cancer. Ultrasound-targeted microbubble destruction (UTMD) is a method that increases the absorption of targeted genes or drugs by cells. We focus on the role of UTMD-mediated miR-21 transfection in HeLa cells, a cervical cancer cell line.
Material/Methods
The effects of different ultrasound intensities on the transfection efficiency of miR-21-enhanced green fluorescent protein (EGFP) and miR-21 inhibitor-EGFP plasmids were determined by flow cytometry. The effects of UTMD-mediated miR-21 transfection on HeLa cell proliferation, apoptosis, migration, and invasion were measured by CCK-8, flow cytometry, wound healing experiments, and transwell migration assay, respectively. Western blot and real-time quantitative PCR were used to detect the expression of tumor-related genes.
Results
When the ultrasound intensity was 1.5 W/cm², the miR-21 plasmid had the highest transfection efficiency. Exogenous miR-21 promoted cell proliferation, migration, and invasion, and inhibited cell apoptosis in HeLa cells. Treatment of cells with UTMD further enhanced the effects of miR-21-EGFP and miR-21 inhibitor-EGFP. In addition, miR-21 overexpression significantly increased the expression of p-Akt, Akt, Bcl-2, Wnt, β-catenin, matrix metalloprotein-9 (MMP-9), and epidermal growth factor (EGFR) levels, and decreased Bax expression. The regulatory role of miR-21 inhibitor-EGFP was opposite to that of miR-21-EGFP. After UTMD, miR-21-EGFP and miR-21 inhibitor-EGFP had more significant regulatory effects on these genes.
Conclusions
Our research revealed that an ultrasound intensity of 1.5 W/cm² is the best parameter for miR-21 transfection. UTMD can enhance the biological function of miR-21 in HeLa cells, and alter the effect of miR-21 on apoptosis, metastasis, and phosphorylation genes.
... Moreover, SPMs now account for approximately 17% of all incident cancers reported each year to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program (8). Population-based studies pointed out that CC survivors were at great risk of developing SPMs (9), and these patients were even more likely to die from their SPMs than from their initial cancers (10). ...
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.
... The age-related difference in CRS rates diminished with time, indicating that elderly cancer patients had a higher excess risk for early mortality than younger patients during the post-treatment period. This might be due to undertreatment due to old age [14], higher susceptibility to toxic effects of cancer treatment [15], and higher risks of death from other competing causes, such as cardiovascular disease or second primary cancer [16,17]. This underlines the need for best tolerable treatment at an individual approach without ageist discrimination [18,19], attentive surveillance for recurrence, better management of comorbidities, and thorough screening for other cancers in the elderly patient population [20]. ...
Objective:
Conditional relative survival (CRS) considers changes in prognosis over time and may offer more useful estimates for survivors. We aimed to investigate CRS among patients with cervical cancer stratified by various factors that influence survival probability.
Methods:
This nationwide retrospective study used data from the Korean Central Cancer Registry. We included 78,606 patients diagnosed with cervical cancer as their first cancer between January 1, 1996 and December 31, 2015, and who were followed until December 31, 2016. CRS and the conditional probabilities of death for the following 1 year were stratified by age at diagnosis, histology, cancer stage, treatment, year of diagnosis, and social deprivation index.
Results:
The 5-year relative survival rate at the time of diagnosis was 80.6% for all cases. The probability of surviving an additional 5 years conditioned on having already survived 1, 2, 3, 4, and 5 years after diagnosis was 85.7%, 90.6%, 93.5%, 95.3%, and 94.3%, respectively. Patients with poorer initial survival estimates (older, advanced stage, non-squamous cell histology) generally showed the largest increases in CRS over time. Patients aged ≥70 years had the highest probability of death in the first year after diagnosis (24.5%), but the conditional probability of death in the 2nd, 3rd, 4th, and 5th years declined abruptly to 13.1%, 7.5%, 5.4%, and 3.9%, respectively.
Conclusions:
The CRS rates for patients with cervical cancer improved over time, particularly among patients with poorer initial prognoses. Our estimates enable patients to make better informed decisions regarding follow-up care and their personal life.
... For women with cervical cancer, the 10-year overall survival is poorer in cases with a second primary cancer. 7 ...
Background: Ca cervix is a major cause of morbidity and mortality, particularly in developing countries like India.Itsecond most common cancer in females after breast cancer.2 nd malignancy site after treatment of ca cervix can be related to radiation dose and radiation portal used e.g ca bladder,ca vagina, ca rectum, it can also be related to same etiological factor such as smoking e.g lung/bronchus/esophageal cancer or HPV related cancers like vagina, vulva, or anal cancer. Case Report: We report a case of 56-year old female patient who was diagnosed as CA Cervix IIB and treated 10 years ago in our institutewith 45Gy/20#/4 weeks of radiation therapy along with low dose rate intra cavitary brachytherapy consisting of 35Gy.She was on regular follow up for 5 years after which she defaulted and finally reported in department of pulmonary medicine with the chief c/o hemoptysis, She was diagnosed as a case of NSCLC with skeletal mets and pathological #proximal tibial shaft. Patient treated with palliative intent with stabilization of fracture, chemotherapy, and radiotherapy. Results: After adequate palliation patient is symptomatically better however prognosis remains dismal.
... On the other hand, rectal cancer, hepatocellular carcinoma, and gastric cancer (1.0, 1.2 and, respectively) possessed the lowest relative risk rates. Lim et al. came up with a data of 72,805 invasive cervical cancer patients after pelvic irradiation within a study period of 7.34 years [28]. A 3.68% rate (2678 cases) of secondary radiation-induced malignancies with similar relative risk patterns-vagina (9.36), soft tissues and bones (2.7), vulva (2.58), and anus and anal canal (2.42)-was observed. ...
Background:
Incidence of cervical cancer among women of reproductive age still remains significantly high. In regard to prognostic features and risk factors, the standard treatment for most types of cervical cancer represents a combination of surgical treatment and radiation therapy, such as external beam radiation therapy and brachytherapy. Despite significant advances of long-term oncological outcomes, radiation-induced secondary malignancies among cervical cancer survivors are still an issue. Current case report describes an incredibly rare case of radiation-induced leiomyosarcoma of the rectum, which occurred 32 years after cervical cancer treatment.
Case presentation:
A 62-year-old female had a past medical history of FIGO stage IIB cervical cancer (squamous cell carcinoma pT2bN0M0). In 1987, she underwent radical hysterectomy with bilateral iliac lymph node dissection, followed by adjuvant radiation therapy-70 Gy external beam pelvic irradiation followed by 30.5 Gy of brachytherapy. Thirty-two years later, she presented with signs of rectal bleeding. Regarding past medical history, radiologic, endoscopic, and pathologic data, the patient was initially diagnosed with a malignant nonepithelial lower rectal tumor of the unknown origin and staged as mrT3a mrN0 cM0. Total mesorectal excision with complete mesocolic excision and central vascular ligation (CME/CVL) carried by an open approach was carried out. In an attempt to identify the tissue of origin, an immunohistochemistry assay had been performed. Tumor cells showed a high rate of mitotic activity with a 45% rate of Ki-67 expression, positive reaction for desmin, and SMA in all samples. Negative reaction for CD117 and S100 was observed. As a conclusion, the immunophenotype was identified as a grade 3 leiomyosarcoma (ISD-code 8890/3).
Conclusions:
We suggest that up to date, radical surgery with curative intent, as it was performed in our study, is the most evidence-based treatment option for patients with radiation-induced sarcomas of the rectum.
