Huaqiang Zhou1,2, Jiayi Shen2, Yaxiong Zhang1,2, Yan Huang1, Wenfeng Fang1, Yunpeng Yang1, Shaodong Hong1, Jiaqing Liu2, Wei Xian2, Zhonghan Zhang1, Yuxiang Ma3, Ting Zhou1, Hongyun Zhao1, Li Zhang1. 1. Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. 2. Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510060, China. 3. Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
Abstract
BACKGROUND: With the improvement of survival for non-small cell lung cancer (NSCLC), research focused on second primary malignancy (SPM) in NSCLC survivors is becoming urgent. This study aimed to estimate the risk of SPM in NSCLC patients. METHODS: We retrospectively analysed NSCLC patients diagnosed between 2004 and 2010 in SEER database. We firstly evaluated the crude and cumulative incidence of SPM. SPM incidence in NSCLC survivors compared to that in the reference population was calculated as standardized incidence ratio (SIR). A competing risk nomogram was also built, to predict the incidence of SPM. RESULTS: The crude and 10-year cumulative incidences of SPM were 4.04% and 5.05%, respectively, while the SIR was 1.62. The nomogram was well calibrated and had good discriminative ability, with c-index of 0.80. It showed a significantly wide interval of SPM cumulative incidence between the first and tenth-decile according to the risk model (1.04% vs. 16.70%, P<0.05). The decision curve analysis indicated that the clinical net benefit of risk model was larger than that in other scenarios (all-screening or no-screening) in a range of threshold probabilities (1% to 20%). CONCLUSIONS: Our study firstly performed a systematic estimation of the incidence of SPM in NSCLC, which implied the necessity of a risk predicting model. We developed the first competing risk nomogram to predict the risk of SPM, which performed well in the evaluation and might be helpful for individualized SPM screening. 2019 Annals of Translational Medicine. All rights reserved.
BACKGROUND: With the improvement of survival for non-small cell lung cancer (NSCLC), research focused on second primary malignancy (SPM) in NSCLC survivors is becoming urgent. This study aimed to estimate the risk of SPM in NSCLC patients. METHODS: We retrospectively analysed NSCLC patients diagnosed between 2004 and 2010 in SEER database. We firstly evaluated the crude and cumulative incidence of SPM. SPM incidence in NSCLC survivors compared to that in the reference population was calculated as standardized incidence ratio (SIR). A competing risk nomogram was also built, to predict the incidence of SPM. RESULTS: The crude and 10-year cumulative incidences of SPM were 4.04% and 5.05%, respectively, while the SIR was 1.62. The nomogram was well calibrated and had good discriminative ability, with c-index of 0.80. It showed a significantly wide interval of SPM cumulative incidence between the first and tenth-decile according to the risk model (1.04% vs. 16.70%, P<0.05). The decision curve analysis indicated that the clinical net benefit of risk model was larger than that in other scenarios (all-screening or no-screening) in a range of threshold probabilities (1% to 20%). CONCLUSIONS: Our study firstly performed a systematic estimation of the incidence of SPM in NSCLC, which implied the necessity of a risk predicting model. We developed the first competing risk nomogram to predict the risk of SPM, which performed well in the evaluation and might be helpful for individualized SPM screening. 2019 Annals of Translational Medicine. All rights reserved.
Entities:
Keywords:
Neoplasms; SEER program; non-small cell lung cancer (NSCLC); risk; second primary carcinoma
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