Impact of second primary tumors on survival in head and neck cancer: an analysis of 2,063 cases

Laryngoscope. 2008 Aug;118(8):1350-6. doi: 10.1097/MLG.0b013e318172ef9a.


Objective/hypothesis: To investigate the impact of second primary tumors on prognosis for patients with head and neck squamous cell carcinoma (HNSCC).

Study design: Prospectively recorded data on HNSCC patients treated at an academic tertiary referral center.

Methods: An analysis of 2,063 patients treated over a 15 year period for tumors of the upper aerodigestive tract, with a minimum follow-up of 10 years.

Results: A total of 351 (17%) patients developed a second primary, mean time to diagnosis of the second tumor being more than 4 years from the date of the initial tumor. Median overall survival from the date of the first tumor among patients who later developed a second primary was 6 years versus 3 years among all other patients (P < .05). During the first 6 years after treatment of the initial tumor, cancer specific survival was better in the second primary group. After diagnosis of a second primary tumor, median survival was 12 months. A positive correlation was found between second primaries and stage I/II primary disease, low patient age, and initial tumors of the larynx and oral cavity.

Conclusions: The group of patients with the highest risk of a second primary tumor was younger patients with limited initial tumors. A high proportion of patients who later developed a second primary were complete responders after treatment of the first tumor. However, prognosis was poor after the actual diagnosis of the second primary tumor.

MeSH terms

  • Actuarial Analysis
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / classification
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / classification
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / pathology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Second Primary / classification
  • Neoplasms, Second Primary / mortality*
  • Neoplasms, Second Primary / pathology
  • Prognosis
  • Prospective Studies
  • Survival Rate