美國成年癌症倖存者中初次原發癌與繼發原發癌風險的相關性
作者：
小柯機器人發布時間：2020/12/25 14:45:20
美國癌症協會Ahmedin Jemal團隊研究了成年癌症倖存者中初次原發癌與繼發原發癌風險的相關性。2020年12月22日，該研究發表在《美國醫學會雜誌》上。
預計癌症倖存者新發癌症的數量會增加，但關於成年癌症倖存者中繼發原發癌（SPC）的風險尚不明確。
為了通過初次原發癌（FPC）的類型和性別來量化成年癌症倖存者中SPC的總體風險和特定癌症類型的風險，研究組在美國進行了一項回顧性隊列研究，共招募了1537101例於1992-2011年（隨訪至2017年12月31日）被確診為FPC的20-84歲的參與者，均存活5年以上。主要結局為每10000人年的SPC發生率和死亡率；與普通人群相比，標準化發病率（SIR）和標準化死亡率（SMR）。
這些癌症倖存者的平均年齡為60.4歲，女性佔48.8％。在11197890人-年的隨訪期間（平均7.3年），共有156442例發生SPC，88818例因SPC死亡。在男性中，30種FPC類型中有18種罹患任何SPCs的總體風險顯著升高，有27種罹患任何SPCs的風險在統計學上顯著高於普通人群。在女性中，31種FPC類型中有21種罹患任何SPCs的總體風險顯著升高，有28種罹患任何SPCs的風險在統計學上顯著高於普通人群。
男性中喉癌和膽囊癌倖存者的SIR和SMR最高，女性中喉癌倖存者的SIR和SMR最高。特定類型的FPC與特定類型的SPC風險之間存在較大差異。但是，只有少數與吸菸或肥胖相關的SPC，例如肺、膀胱、口腔/咽部、結直腸、胰腺、子宮體和肝臟的癌症，在總發病率和死亡率中佔相當大的比例，僅肺癌就佔了所有SPC死亡的31-33％。
研究結果表明，美國成年癌症倖存者與普通人群相比，幾種類型的原發癌發生SPC和死亡的風險更高。在所有倖存者中，與吸菸或肥胖相關的癌症在SPC總體發病率和死亡率佔很大比例，並突出了持續監測和努力預防倖存者中新癌症的重要性。
附：英文原文
Title: Association of First Primary Cancer With Risk of Subsequent Primary Cancer Among Survivors of Adult-Onset Cancers in the United States
Author: Hyuna Sung, Noorie Hyun, Corinne R. Leach, K. Robin Yabroff, Ahmedin Jemal
Issue&Volume: 2020/12/22
Abstract:
Importance The number of cancer survivors who develop new cancers is projected to increase, but comprehensive data on the risk of subsequent primary cancers (SPCs) among survivors of adult-onset cancers are limited.
Objective To quantify the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types and sex.
Design, Setting, and Participants A retrospective cohort study from 12 Surveillance, Epidemiology, and End Results registries in the United States, that included 1537101 persons aged 20 to 84 years diagnosed with FPCs from 1992-2011 (followed up until December 31, 2017) and who survived at least 5 years.
Exposures First primary cancer.
Main Outcomes and Measures Incidence and mortality of SPCs per 10000 person-years; standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with those expected in the general population.
Results Among 1537101 survivors (mean age, 60.4 years; 48.8% women), 156442 SPC cases and 88818 SPC deaths occurred during 11197890 person-years of follow-up (mean, 7.3 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 18 of the 30 FPC types, and risk of dying from any SPCs was statistically significantly higher for 27 of 30 FPC types as compared with risks in the general population. Among women, the overall risk of developing any SPCs was statistically significantly higher for 21 of the 31 FPC types, and risk of dying from any SPCs was statistically significantly higher for 28 of 31 FPC types as compared with risks in the general population. The highest overall SIR and SMR were estimated among survivors of laryngeal cancer (SIR, 1.75 [95% CI, 1.68-1.83]; incidence, 373 per 10000 person-years) and gallbladder cancer (SMR, 3.82 [95% CI, 3.31-4.39]; mortality, 341 per 10000 person-years) among men, and among survivors of laryngeal cancer (SIR, 2.48 [95% CI, 2.27-2.72]; incidence, 336 per 10000 person-years; SMR, 4.56 [95% CI, 4.11-5.06]; mortality, 268 per 10000 person-years) among women. Substantial variation existed in the associations of specific types of FPCs with specific types of SPC risk; however, only a few smoking- or obesity-associated SPCs, such as lung, urinary bladder, oral cavity/pharynx, colorectal, pancreatic, uterine corpus, and liver cancers constituted considerable proportions of the total incidence and mortality, with lung cancer alone accounting for 31% to 33% of mortality from all SPCs.
Conclusions and Relevance Among survivors of adult-onset cancers in the United States, several types of primary cancer were significantly associated with greater risk of developing and dying from an SPC, compared with the general population. Cancers associated with smoking or obesity comprised substantial proportions of overall SPC incidence and mortality among all survivors and highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors.
DOI: 10.1001/jama.2020.23130
Source: https://jamanetwork.com/journals/jama/article-abstract/2774406