Table_1_Risk of Second Primary Malignancies in Colon Cancer Patients Treated With Colectomy.DOCX

Background: Second primary malignancy (SPM) attracts a growing attention. However, the clinical features of colon cancer (CC) survivors with SPMs are not clear and could help guide clinicians to develop a better surveillance strategy.Methods: We reviewed 56,930 CC survivors treated with colectomy from the Surveillance, Epidemiology, and End Results (SEER) database during 1998–2011. Competing risk models and nomograms were conducted for predicting the risk of occurring SPMs. The clinical utility of the models was measured by decision curve analysis (DCA) using net benefit approaches.Results: Five thousand thirteen (17.1%) of male patients developed SPMs and sites of SPMs included prostate (32.2%), lung and bronchus (11.6%), urinary bladder and kidney (10.8%), colon (10.0%), and melanoma of the skin (3.9%), while 3,592 (13.0%) of female patients occurred SPMs and sites of SPMs involved breast (25.8%), lung and bronchus (13.6%), colon (11.6%), uterus (8.2%), urinary bladder, and kidney (5.6%). Survivors with a second carcinoma of lung and bronchus showed the worst prognosis. Older age increased the risk of SPMs in both male (Subdistribution hazard ratio =2.85 [95% confidence interval = 2.53–3.21]) and female (1.80 [1.59–2.04]) survivors, especially for the risk of a second prostate carcinoma in male (5.33 [4.03–7.03]). Compared with white race, black male survivors remained at higher risk to develop the second prostate carcinoma (1.98 [1.74–2.26]). Competing-risk nomograms for CC survivors were established to help clinicians predict the probabilities of overall SPMs and prostate carcinoma. Validation of nomograms showed good discrimination and accuracy, and DCAs revealed the clinical effectiveness.Conclusions: We profiled the clinical characteristics of a large population-based cohort of CC survivors with SPMs. These features may improve future follow-up management, especially for the surveillance of second prostate cancer in men and second breast cancer in women.

背景：继发性恶性肿瘤（SPM）日益受到关注。然而，结肠癌（CC）幸存者伴发SPM的临床特征尚不明确，这有助于指导临床医生制定更优的监测策略。方法：我们回顾了1998年至2011年间SEER数据库中接受结肠切除术治疗的56,930名CC幸存者的数据。通过竞争风险模型和诺谟图预测SPM的发生风险。模型的临床效用通过决策曲线分析（DCA）和净效益方法进行评估。结果：5,013名（17.1%）男性患者发生了SPM，SPM的发生部位包括前列腺（32.2%）、肺和支气管（11.6%）、膀胱和肾脏（10.8%）、结肠（10.0%）以及皮肤黑色素瘤（3.9%），而3,592名（13.0%）女性患者发生了SPM，SPM的发生部位涉及乳腺（25.8%）、肺和支气管（13.6%）、结肠（11.6%）、子宫（8.2%）、膀胱和肾脏（5.6%）。肺和支气管的二次癌患者预后最差。年龄的增长增加了男性和女性幸存者发生SPM的风险（男性亚分布风险比=2.85[95%置信区间=2.53–3.21]，女性1.80[1.59–2.04]），尤其是男性发生第二次前列腺癌的风险（5.33[4.03–7.03]）。与白人幸存者相比，黑人男性幸存者发生第二次前列腺癌的风险更高（1.98[1.74–2.26]）。为CC幸存者建立了竞争风险诺谟图，以帮助临床医生预测整体SPM和前列腺癌的概率。诺谟图的验证显示具有良好的区分度和准确性，决策曲线分析揭示了临床有效性。结论：我们对一个大型基于人群的CC幸存者伴SPM的临床特征进行了分析。这些特征可能改善未来的随访管理，特别是男性第二前列腺癌和女性第二乳腺癌的监测。