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Second Primary Malignancies in Cancer Survivors: Incidence, Risk Factors, and Clinical Outcomes

Author(s) Kyprianos Kottis, Vasileios Giannakos, Evangelia Asvou, katerina Kotsoni, Evangelos Armpatsis
Country Germany
Abstract Background
Improved survival of cancer patients due to development in cancer therapy has contributed to an increase in the number of cancer survivors at risk for second primary malignancies (SPMs). The occurrence of SPM is a unique entity that differs from local recurrence or metastasis, which causes significant morbidity and mortality. Although SPMs have immense clinical significance, the epidemiology, risk factors, and outcomes are not well studied in different groups of cancers.

Objectives
Objectives of this SLR and meta-analysis include: (1) assessment of overall incidence rate of SPMs in cancer survivors from different index cancer types; (2) identification and quantification of independent risk factors for SPMs development, which may involve treatment-related, genetic and lifestyle risk factors; and (3) determination of clinical outcomes of cancer survivors with SPMs, such as overall survival and quality of life.

Methods
A structured search will be performed on MEDLINE/PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science databases up to May 2026, following PRISMA 2020. All studies with information on the incidence, risk factors, or outcomes of SPMs among adult cancer survivors (≥18 years) will be eligible for inclusion. The pooled incidences, standardized incidence ratios (SIRs), and hazard ratios (HRs) will be calculated using random-effects meta-analyses. Heterogeneity will be quantified with the use of the I² and Q statistics. The risk of bias will be appraised by the Newcastle-Ottawa Scale (NOS).

Expected Outcomes
These meta-analytical studies are supposed to provide strong and pooled epidemiological data on the incidence and risks of SPMs according to cancer types, modes of treatment, periods of follow-up, and demographic features of patients.
Keywords Second primary malignancy; cancer survivors; incidence; risk factors; systematic review; meta-analysis; survivorship; treatment-related cancer; standardized incidence ratio
Field Biology
Published In Volume 7, Issue 6, June 2026
Published On 2026-06-30
DOI https://doi.org/10.70528/IJLRP.v7.i6.2274
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