Second primary head and neck cancers after non-head and neck primary cancers

Publication date: Available online 20 May 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Thomas Schlieve, R. Eric Heidel, Eric R. Carlson
PurposeThe purpose of this study was to determine the rate of second primary head and neck cancer development among patients with a primary cancer diagnosed outside of the head and neck region, to present the clinical characteristics of this population, and to determine if any variables are associated with survival.Patients and methodsThe investigators designed a case series based on a sample of patients diagnosed with head and neck cancer who were previously diagnosed with a cancer located outside of the head and neck region. The primary predictor variable was a diagnosis of cancer outside of the head and neck region. The primary outcome variable was the diagnosis of a second cancer in the head and neck region. Chi-square Goodness-of-fit tests were used to test differences between observed rates and expected rates.ResultsThere were 19,406 total cancers diagnosed at the University of Tennessee Cancer Institute during the study period from July 1, 2004 to June 30, 2014. The rate of second primary head and neck cancer among patients with a non-head and neck primary cancer was 0.2%. These 40 cancers occurred among a total of 849 head and neck squamous cell carcinoma (HNSCC) cases (5%) diagnosed during this time period. The most common location for a second primary HNSCC was the gingiva (27.5%), followed by the oral tongue (17.5%). There were significantly more gingival cancers than expected (p < .001) and significantly fewer tongue cancers than expected (p = .01). The most common primary cancer was prostate (27.5%) followed by breast (25%). Median survival was 28.5 months following second primary diagnosis. There was a non-significant effect for age (p = .30), tobacco use (p = .12), gender (p = .60), TNM stage (p = .29), and treatment protocol (p = .96) on survival.ConclusionSecond primary HNSCC in a population of patients with non-head and neck primary cancers is associated with decreased overall survival. The most common presentation of a second primary HNSCC is in the gingiva and the most common primary cancer is located in the prostate. Clinicians should consider the increased proportion of gingival cancers in this population when examining patients and be aware of the decrease in overall survival.



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