Risk patterns of subsequent primary cancers following esophagectomy in early-stage thoracic esophageal squamous cell cancer patients


Aims and Background

Subsequent primary cancers (SPCs) have been demonstrated to be the major causes of death among patients with thoracic esophageal squamous cell cancer (ESCC) negative for lymph node involvement. We designed this study to investigate clinical characteristics and risk patterns of SPCs following esophagectomy in patients with early-stage thoracic ESCC.


We retrospectively analyzed clinical factors in 512 patients with early-stage thoracic ESCC collected from 3 independent hospitals over a 10-year interval.


The overall standard incidence rate (SIR) of SPCs was 3.84 (95% confidence interval 2.98-4.95). The most common SPCs were head and neck cancers, lung cancer, and stomach cancer. The risk patterns of SPCs varied across organs. A 3-phase risk pattern with a U-shaped curve between 2 rising phases was seen for head and neck cancers, while for the other cancers, the risk patterns all displayed as an approximately linear upward trend. It was further noted that sex, smoking habits, and cancer histories among first-degree relatives were 3 significant independent risk factors in the development of SPCs.


We observed significant associations between early-stage ESCC and SPCs arising from anatomically adjacent sites. The different risk patterns of SPCs indicated that follow-up strategies should be established accordingly in different organs at different times, with particularly close follow-up for head and neck cancers in the first 5 years and beyond 15 years after diagnosis of ESCC.

Tumori 2015; 101(3): 328 - 333




Wen-Si Hu, Zeng-Jun Liu, Jian-Bo Zhang, Zeng-Liang Wang, Ning Yang, Liang Xu, Hui Tian, Pin-Liang Zhang

Article History


Financial support: None.
Conflict of interest: None.

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  • Department of Thoracic Surgery, Qi Lu Hospital, Shandong University, Jinan, Shandong Province - P.R. China
  • Department of Internal Medicine, Shandong Cancer Hospital, Jinan, Shandong Province - P.R. China
  • Department of Pathology, Shandong Cancer Hospital, Jinan, Shandong Province - P.R. China
  • Department of Epidemiology and Biostatistics, Shandong Cancer Hospital, Jinan, Shandong Province - P.R. China
  • Department of Radiation Oncology, Shandong Provincial Hospital, Jinan, Shandong Province - P.R. China
  • Department of Imaging, Shandong Cancer Hospital, Jinan, Shandong Province - P.R. China

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