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Analysis of chemotherapy effect on the second primary malignancy for head and neck cancer patients by a nomogram based on SEER database

机译:基于SEER数据库的NOM图对颈部癌症患者的第二个原发性恶性化疗疗效分析

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摘要

Second primary malignancy (SPM) ranks the second leading cause of death in patients with head and neck cancer (HNC), while studies exploring the risk factors for SPM are limited. To clarify this, we investigated the relationship between the chemotherapy and SPM using the Surveillance, Epidemiology, and End Results (SEER) database. 11 345 patients initially diagnosed with HNC between 1998 and 2016 were selected from the SEER database. First, these patients were divided into two groups according to chemotherapy or not. With Fine and Gray model, the subdistribution hazard ratio (sHR) of chemotherapy was calculated based on Propensity Score Matching (PSM). Second, the 11 345 cases were randomized into a training set and a validation set. Based on the training set, the different cumulative incidence of SPMs between the patients with and without chemotherapy was estimated respectively in the high‐ and low‐risk group according to the scores derived from a nomogram. Chemotherapy was negatively correlated to the SPMs (sHR: 0.847, 95% CI: 0.733‐0.977, P = .023) by conducting competing risk analysis. With chemotherapy, forest plots showed subgroups of squamous cell carcinoma (SCC, sHR: 0.815, 95% CI: 0.7‐0.948, P = .008), 50‐64 years old (sHR:0.794, 95% CI: 0.655‐0.962, P = .019), male (sHR:0.828, 95% CI: 0.703‐0.974, P = .023), and well/moderate histological grade (sHR:0.828, 95% CI: 0.688‐0.996, P = .045) were negatively correlated to SPMs; the nomogram showed the high‐risk population characterized as SCC, elder age, male, and well/moderate histological grade also tended to have lower incidence of SPMs (sHR: 0.805, 95% CI: 0.669‐0.969, P = .022). Despite HNC patients with characteristics of SCC, increased age, male, and well/moderate histological grade had higher risk of a SPM, they were also more likely to be benefitted from chemotherapy to avoid it.
机译:第二次初级恶性肿瘤(SPM)在头部和颈部癌症(HNC)患者中排名第二次死亡原因,而探索SPM的风险因素的研究有限。为了澄清这一点,我们使用监测,流行病学和最终结果(SEER)数据库来调查化疗和SPM之间的关系。 11 345初期诊断为1998年至2016年间核查HNC的患者被选自SEER数据库。首先,这些患者根据化疗或不分为两组。通过细细和灰色模型,基于倾向得分匹配(PSM)计算化疗的分区危险比(SHR)。其次,1145个案例被随机分为训练集和验证集。基于培训集,根据源自罗维图的分数分别估计有患者和无需化疗的患者和无需化疗之间的不同累积发病率。通过进行竞争风险分析,化疗与SPMS(SHR:0.847,95%CI:0.733-0.977,P = .023)负相关。通过化疗,森林地块显示鳞状细胞癌的亚组(SCC,SCR:0.815,95%CI:0.7-0.948,P = .008),50-64岁(SHR:0.794,95%CI:0.655-0.962, p = .019),雄性(SHR:0.828,95%CI:0.703-0.974,P = .023),以及井/中度组织学等级(SHR:0.828,95%CI:0.688-0.996,P = .045)与SPM呈负相关; NOM图显示出称为SCC,年龄,男性和良好/中度组织学等级的高风险群体也倾向于具有较低的SPMS发病率(SHR:0.805,95%CI:0.669-0.969,P = .022)。尽管HNC具有SCC特征的患者,年龄增加,男性和良好/中度的组织学等级具有更高的SPM风险,但它们也更有可能受益于化疗以避免它。

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