Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis

Area of Science:

• Oncology
• Cancer Survivorship
• Epidemiology

Background:

• Second primary malignancies (SPMs) pose a growing threat to cancer survivors.
• Limited data exists on the characteristics and outcomes of hepatocellular carcinoma (HCC) patients with SPMs.

Purpose of the Study:

• To investigate the characteristics of HCC patients who develop SPMs.
• To identify HCC patients at high risk for developing SPMs.

Main Methods:

• Retrospective analysis of 40,314 HCC patients from the 2000-2014 SEER database.
• Utilized Fine-Gray proportional subdistribution hazards model and a competing-risk model to identify risk factors and predict SPM probability.
• Evaluated nomogram performance using calibration curves, concordance index (C-index), and decision curve analysis (DCA).

Main Results:

• 3.95% of HCC patients developed SPMs, with 3-, 5-, and 10-year cumulative incidences of 2.35%, 3.12%, and 4.51%, respectively.
• Independent risk factors for SPMs included age at diagnosis, disease extent, tumor size, and treatment.
• A competing-risk nomogram demonstrated good predictive performance (C-index=0.677) and clinical utility via DCA.

Conclusions:

• HCC survivors have a high risk of developing SPMs, influenced by clinical features and treatment.
• A validated competing-risk nomogram can aid in identifying high-risk HCC patients for SPM management.
• This tool supports improved clinical decision-making and patient care for HCC survivors.