Schaapveld Michael, Visser Otto, Louwman Marieke J, de Vries Elisabeth G E, Willemse Pax H B, Otter Renée, van der Graaf Winette T A, Coebergh Jan-Willem W, van Leeuwen Flora E
Comprehensive Cancer Center North-Netherlands (CCCN), P.O. Box 330, 9700 AH Groningen, The Netherlands.
J Clin Oncol. 2008 Mar 10;26(8):1239-46. doi: 10.1200/JCO.2007.11.9081.
To assess the risk of secondary nonbreast cancers (SNBCs) in a recently treated population-based cohort of breast cancer patients focused on the association with treatment and prognostic implications.
In 58,068 Dutch patients diagnosed with invasive breast cancer between 1989 and 2003, SNBC risk was quantified using standardized incidence ratios (SIRs), cumulative incidence, and Cox regression analysis, adjusted for competing risks.
After a median follow-up of 5.4 years, 2,578 SNBCs had occurred. Compared with the Dutch female population at large, in this cohort, the SIR of SNBCs was increased (SIR, 1.22; 95% CI, 1.17 to 1.27). The absolute excess risk was 13.6 (95% CI, 9.7 to 17.6) per 10,000 person-years. SIRs were elevated for cancers of the esophagus, stomach, colon, rectum, lung, uterus, ovary, kidney, and bladder cancers, and for soft tissue sarcomas (STS), melanoma, non-Hodgkin's lymphoma, and acute myeloid leukemia (AML). The 10-year cumulative incidence of SNBCs was 5.4% (95% CI, 5.1% to 5.7%). Among patients younger than 50 years, radiotherapy was associated with an increased lung cancer risk (hazard ratio [HR] = 2.31; 95% CI, 1.15 to 4.60) and chemotherapy with decreased risk for all SNBCs (HR = 0.78; 95% CI, 0.63 to 0.98) and for colon and lung cancer. Among patients age 50 years and older, radiotherapy was associated with raised STS risk (HR = 3.43; 95% CI, 1.46 to 8.04); chemotherapy with increased risks of melanoma, uterine cancer, and AML; and hormonal therapy with all SNBCs combined (HR = 1.10; 95% CI, 1.01 to 1.21) and uterine cancer (HR = 1.78; 95% CI, 1.40 to 2.27). An SNBC worsened survival (HR = 3.98; 95%CI 3.77 to 4.20).
Breast cancer patients diagnosed in the 1990 s experienced a small but significant excess risk of developing an SNBC.
在近期接受治疗的基于人群的乳腺癌患者队列中，评估继发性非乳腺癌（SNBC）的风险，重点关注其与治疗的关联及预后影响。
在1989年至2003年间诊断为浸润性乳腺癌的58068名荷兰患者中，使用标准化发病比（SIR）、累积发病率和Cox回归分析对SNBC风险进行量化，并针对竞争风险进行调整。
中位随访5.4年后，发生了2578例SNBC。与荷兰总体女性人群相比，该队列中SNBC的SIR升高（SIR为1.22；95%CI为1.17至1.27）。每10000人年的绝对超额风险为13.6（95%CI为9.7至17.6）。食管癌、胃癌、结肠癌、直肠癌、肺癌、子宫癌、卵巢癌、肾癌和膀胱癌以及软组织肉瘤（STS）、黑色素瘤、非霍奇金淋巴瘤和急性髓细胞白血病（AML）的SIR均升高。SNBC的10年累积发病率为5.4%（95%CI为5.1%至5.7%）。在50岁以下的患者中，放疗与肺癌风险增加相关（风险比[HR]=2.31；95%CI为1.15至4.60）；化疗与所有SNBC风险降低相关（HR=0.78；95%CI为0.63至0.98），与结肠癌和肺癌风险降低也相关。在50岁及以上的患者中，放疗与STS风险升高相关（HR=3.43；95%CI为1.46至8.04）；化疗与黑色素瘤、子宫癌和AML风险增加相关；激素治疗与所有SNBC合并风险增加相关（HR=1.10；95%CI为1.01至1.21），与子宫癌风险增加相关（HR=1.78；95%CI为1.40至2.27）。SNBC会使生存率恶化（HR=3.98；95%CI为3.77至4.20）。
20世纪90年代诊断出的乳腺癌患者发生SNBC的风险虽小但显著增加。
