AI Networking Cookbook: Practical recipes for AI-assisted network automation and development
TL;DR
Young-onset bladder cancer survivors experience a sustained elevation in second primary malignancy risk, underscoring the importance of long-term survivorship awareness and informing counseling and follow-up strategies in this population.
BACKGROUND The development of second primary cancers (SPCs) has become an important late effect in gastric cancer (GC) survivors, yet its incidence, risk factors, and clinical implications remain poorly defined. This study aimed to evaluate the long-term risk of SPCs, identify clinical factors associated with SPC occurrence, and describe detection patterns and stage distribution of SPCs during long-term follow-up. METHODS Patients with GC who underwent curative-intent radical gastrectomy between 2007 and 2021 were identified from the Multidisciplinary Alliance of Gastric Integrative Studies (MAGIS) cohort. Clinical factors associated with SPC occurrence were selected using LASSO-penalized Cox regression, and exploratory risk-based stratification was performed. Stage distribution was descriptively compared between SPCs detected during asymptomatic surveillance and those diagnosed after symptom onset. RESULTS Among 11,027 GC survivors (8,519 men and 2,508 women), 241 (2.19%) developed SPCs during a follow-up of up to 16 years. The cumulative incidence of SPCs was 1.25% (95% CI, 1.03%-1.46%) at 5 years, 2.97% (95% CI, 2.55%-3.39%) at 10 years, and 4.15% (95% CI, 3.40%-4.91%) at 15 years after gastrectomy. The most frequent SPCs were lung (23.2%), colorectal (21.6%), and esophageal (12.9%) cancers, showing marked sex-specific differences: lung cancer predominated in males, whereas cervical cancer was most common in females. Factors associated with SPC occurrence included older age at time of gastrectomy (HR 1.04, 95% CI 1.02-1.05; p < 0.001), chronic HBV/HCV infection (HR 2.15, 95% CI 1.29-3.58; p = 0.003), family history of cancer (HR 1.57, 95% CI 1.16-2.12; p = 0.003), and elevated preoperative systemic inflammation (Log-SIRI; HR 1.86, 95% CI 1.31-2.65; p < 0.001). The derived model stratified patients into low-, intermediate-, and high-risk groups with corresponding 10-year SPC risks of 2.07%, 3.61%, and 4.33%. SPCs detected during asymptomatic surveillance were more frequently diagnosed at stage I than those identified after symptom onset (47.4% vs 17.6%; p < 0.001). CONCLUSIONS SPCs represent an important long-term health burden among GC survivors, with distinct sex-specific disease patterns. The exploratory risk-scoring model showed preliminary risk stratification, and SPCs detected during asymptomatic surveillance were more often diagnosed at an earlier stage. These findings support further evaluation of risk-adapted, organ- and sex-specific surveillance strategies in methodologically rigorous studies.
Background: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy among children, adolescents, and young adults (CAYA). While prognosis is generally favorable, rising incidence, longer survivorship, and radioactive iodine (RAI) treatment raise concern for late effects, particularly second primary malignancies (SPMs) and late mortality. Objective: To evaluate SPM risk, all-cause mortality, and the impact of RAI in CAYA DTC survivors. Methods: Retrospective cohort study (1982–2022) using Clalit Health Services records, including DTC patients diagnosed <40 years, who survived ≥2 years. Participants were matched to cancer-free controls (1:4) by birth year, sex, ethnicity, and socioeconomic status. Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Among 5267 DTC survivors (n = 497 [∼9.5%] diagnosed before age 20 years) and 21,062 matched controls, SPM incidence was higher in survivors with 50% increased risk (500 vs. 360 per 100,000 person-years; HR 1.50, CI 1.34–1.67) and occurred after a shorter latency (13.8 vs. 15.1 years; p = 0.042). Survivors diagnosed before age 20 were significantly younger at data retrieval than those diagnosed at 20–40 years (median 33 vs. 47 years; p < 0.001) and had significantly lower SPM rates (n = 28 [5.6%] vs. n = 398 [9.0%]; p = 0.012). Compared with RAI-untreated survivors, SPM risk increased after one RAI treatment (HR 1.91, CI 1.52–2.40) and further after ≥2 RAI treatments (HR 2.73, CI 2.13–3.50). Overall mortality rate was low (n = 148, 2.8%) and similar to that of matched controls (n = 517, 2.5%) but was significantly higher among survivors who developed SPMs and/or received RAI treatment (p < 0.001). Conclusions: Over four decades of follow-up, SPMs were identified as a significant long-term risk among CAYA DTC survivors, frequently manifesting many years after the initial diagnosis. Both SPM occurrence and higher cumulative RAI doses were associated with increased mortality. These findings support careful risk-adapted use of RAI and underscore the need for extended surveillance, particularly for those diagnosed in childhood or adolescence, as malignancies may arise many years after diagnosis.
Background and objectives: Melanoma survivors may develop additional primary malignancies, but data from Eastern European hospital cohorts are scarce. We aimed to estimate the observed incidence of second primary cancers (SPCs) within a Romanian referral-centre cohort, identify associated factors, and explore the association of SPC occurrence with overall survival. Methods: We conducted a retrospective, hospital-based cohort study of 394 patients with histopathologically confirmed cutaneous melanoma followed at two referral centres in Cluj-Napoca. Additional malignancies were counted as new primaries only when clinical and/or histopathological documentation distinguished them from recurrence or metastasis. Incidence density was expressed per 1000 person-years. Multivariable logistic regression assessed age, sex, residence, and Breslow thickness. Fixed-covariate Cox and Kaplan–Meier analyses were considered exploratory because of immortal-time and competing-risk limitations. Results: Over 1848 person-years, 79 patients (20.1%) developed at least one SPC (131 events; observed incidence 70.9/1000 person-years), most frequently cutaneous (53.6/1000 person-years). SPC occurrence increased with age (Cochran–Armitage Z = 5.63, p < 0.001); the Kaplan–Meier complement estimate reached 20.7% at five years. Age independently predicted SPC (OR 1.86 per decade, p < 0.001), whereas greater Breslow thickness was inversely associated (OR 0.86, p = 0.008). Actinic keratosis showed a strong unadjusted association (OR 6.64, p < 0.001) but was not included in the adjusted model. The fixed-status Cox model showed lower mortality among patients with an SPC (HR 0.36, p < 0.001), a finding vulnerable to detection and immortal-time bias. Conclusions: SPCs were frequent in this hospital cohort and predominantly cutaneous. Older age was an independent predictor, while actinic keratosis was a strong unadjusted marker. Prospective, population-based validation is needed before surveillance intensity is individualised.
PURPOSE Survivors of penile squamous cell carcinoma (SCC) may be at increased risk of second primary cancers (SPCs), but population-based data in the United States are limited. We evaluated SPC risk among pSCC survivors using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We conducted a population-based retrospective cohort study using SEER (2000-2022). Standardized incidence ratios (SIRs) and excess absolute risks (EARs) were used to compare SPC risk with the general population. Fine-Gray competing-risk regression was performed to identify factors associated with SPC development. RESULTS Among 5,378 patients with penile SCC, 599 (11.1%) developed at least 1 SPC. Overall SPC risk was significantly elevated compared with the general population (SIR 1.17; 95% CI 1.09-1.27). Higher relative risks were observed among patients younger than 60 years (SIR 1.48), Black individuals (SIR 1.58), and those with basaloid SCC (SIR 2.12). SPC risk was greatest within the first year after diagnosis (SIR 1.78) and remained elevated within the first 5 years. The highest site-specific risk was observed for cancers of the anus, anal canal, and anorectum (SIR 5.00). In competing-risk analyses, Black race, and basaloid histology were independently associated with increased SPC risk, while advanced stage and absence of surgery were associated with lower observed incidence, likely reflecting competing mortality. CONCLUSIONS Survivors of penile SCC have a significantly increased risk of SPCs, particularly HPV-related malignancies. These findings provide important insight into the timing and distribution of SPC risk following penile SCC and may help inform future survivorship research and clinical awareness of SPC risk in this population.
Introduction: Gallbladder cancer (GBC) is a rare but highly lethal malignancy with significant variability in mortality based on demographic and clinical factors. This study aims to analyze the impact of gender, age, tumor stage, and treatment modalities on mortality in GBC patients, providing a comprehensive overview of the factors influencing survival outcomes. Methods: We conducted a retrospective analysis of 1,527 patients diagnosed with GBC between 2005 and 2021. Data were collected on demographic variables, tumor stage, treatment modalities (chemotherapy, surgery, radiation), and survival outcomes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall and cancer-related mortality, adjusting for potential confounders. Results: The study cohort comprised 1,527 patients, predominantly female (68.11%), with most patients diagnosed between ages 60 and 79 years (56.65%). The majority were married (59.66%), and most tumors were at a regional stage (65.49%) at diagnosis. Non-Hispanic whites were the largest racial group (50.03%), followed by Hispanics (23.51%). A significant proportion of patients resided in metropolitan areas (60.64%) and had annual incomes between $60,000 and $79,999 (41.00%). High rates of radiation (85.46%) and chemotherapy (76.03%) were observed, with 81.34% undergoing surgery. Multivariate analysis revealed that male gender was associated with a higher overall mortality risk (HR=1.19, 95% CI 1.05-1.36, p Conclusion: Our study underscores the critical role of demographic and clinical factors in influencing GBC outcomes. Male gender, older age, and distant tumor stage are significant predictors of higher mortality, while chemotherapy and surgery substantially improve survival. The findings highlight the necessity for targeted interventions and personalized treatment approaches to enhance survival rates in GBC patients, taking into account these key prognostic factors. Further research is warranted to explore the nuanced effects of racial and ethnic disparities in GBC outcomes.
BACKGROUND Melanoma in young adults causes substantial years of life lost because deaths occur early. Detection pathways, reasons for consultation, and sex differences may influence tumor thickness and prognosis, but evidence in this age group remains limited. METHODS We conducted a retrospective cohort study of patients aged 18-44 years with primary cutaneous melanoma diagnosed between 1993 and 2022, with a median follow-up of 142 months. Detection source was classified as self, relatives/friends, or healthcare professionals, and reasons for consultation were recorded for self-detected cases. Outcomes included Breslow thickness (> 2 mm), metastasis, melanoma-related death, survival, and years of life lost. Multivariable logistic regression, Kaplan-Meier analyses, and exploratory Cox regression were performed. RESULTS Among 316 patients, self-detection was the most common pathway (58.9%). Thick melanoma was more frequent in self-detected cases than in those detected by relatives or healthcare professionals (p = 0.003). Male sex and self-detection were independently associated with thick melanoma. Among self-detected cases, nodularity and bleeding were the strongest predictors. Men had higher metastatic progression (33.1% vs. 18.1%, p = 0.002) and melanoma-related mortality (18.7% vs. 11.3%, p = 0.049). Median years of life lost among melanoma deaths was 29.15 years. CONCLUSIONS In young adults, melanoma prognosis is strongly linked to detection pathway, consultation triggers, and sex. Earlier professional evaluation, especially in young men and in lesions with high-risk features, may reduce advanced disease and years of life lost.
We use cookies to run the site and, with your consent, for analytics and to show ads. See our Cookie Policy.