title: Risk patterns of subsequent primary cancers following esophagectomy in early-stage thoracic esophageal squamous cell cancer patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  We retrospectively analyzed clinical factors in 512 patients with early-stage thoracic ESCC collected from 3 independent hospitals over a 10-year interval.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Thoracic Surgery, Qi Lu Hospital, Shandong University, Jinan, Shandong Province - P.R. China.
authors.forename: Wen-Si
authors.initials: WS
authors.lastname: Hu
authors.forename: Zeng-Jun
authors.initials: ZJ
authors.lastname: Liu
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Zhang
authors.forename: Zeng-Liang
authors.initials: ZL
authors.lastname: Wang
authors.forename: Ning
authors.initials: N
authors.lastname: Yang
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.forename: Hui
authors.initials: H
authors.lastname: Tian
authors.forename: Pin-Liang
authors.initials: PL
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006258:Head and Neck Neoplasms / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000209:etiology; D013997:Time Factors