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. 2024 Apr 30;15(2):747-754.
doi: 10.21037/jgo-24-13. Epub 2024 Apr 28.

Multiple primary tumors in patients with surgically treated pancreatic cancer: a SEER population-based study

Minghao Zhang  1 , Nana Li  1 , Kuanjie Ma  1 , Lin Wang  2 , Yurong Cai  1 , Zhen Liu  2
Affiliations

Multiple primary tumors in patients with surgically treated pancreatic cancer: a SEER population-based study

Minghao Zhang et al. J Gastrointest Oncol. .

Abstract

Background: With improving survival after pancreatic cancer (PC) resection, questions emerge concerning risk and patterns of metachronous tumors. We aimed to determine the incidence of multiple primary cancers among postoperative PC survivors.

Methods: Patients undergoing PC surgery from 1975 to 2020 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry. Standardized incidence ratios (SIRs) compared observed-to-expected cancers based on U.S. population rates. Cumulative incidence of secondary tumors was analyzed with Cox regression and cancer-specific survival with Kaplan-Meier curves.

Results: Of 6,100 resected PC patients, 267 (4.38%) developed multiple cancers over 6.2 years median follow-up period. Subsequent malignancies showed a rising cumulative incidence extending beyond 5 years. Lung cancer was the predominant second primary in both males (n=36, SIR 1.87) and females (n=32, SIR 2.17). Prostate (n=33) and breast (n=25) cancers were also common. Risk varied by latency period and gender.

Conclusions: Postoperative PC patients face a measurable risk for secondary cancers. Enhanced long-term surveillance has the potential to improve early detection and outcomes in this survivor population. Our data provides real-world evidence which could help inform surveillance guidelines in the future.

Keywords: Pancreatic cancer (PC); incidence; multiple primary malignancies; onset time; postoperative survivorship.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-13/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of cohort selection.
Figure 2
Figure 2
Impact of adjuvant therapy on cancer-specific survival for resected pancreatic cancer. Kaplan-Meier curves show (A) cancer-specific survival based on use of radiation therapy (red, no radiation; blue, radiation) and (B) cancer-specific survival based on chemotherapy administration (red, no chemotherapy; blue, chemotherapy). P values from log-rank tests and hazard ratios with 95% confidence intervals are inset, demonstrating significantly longer survival with use of radiation (P<0.001, HR: 0.89, 95% CI: 0.84–0.95) and chemotherapy (P<0.001, HR: 0.52, 95% CI: 0.50–0.55) after adjusting for clinical factors. HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
Cumulative incidence of the four most common secondary malignancies over time. Cumulative incidence is shown for (A) lung and bronchus cancer, (B) prostate cancer, (C) breast cancer, and (D) colorectal cancer after surgical resection of pancreatic ductal adenocarcinoma. Dashed lines indicate the 95% confidence intervals around the median onset time in months, derived from Cox regression modeling.
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