Rusthoven Kyle E, Flaig Thomas W, Raben David, Kavanagh Brian D
Department of Radiation Oncology, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045-0508, USA.
Clin Lung Cancer. 2008 Mar;9(2):106-11. doi: 10.3816/CLC.2008.n.016.
Lung cancer screening trials depend on the selection of a sufficiently high-risk population. Because not all smokers develop cancer, we hypothesize that a history of tobacco-associated malignancy might more reliably predict for subsequent lung cancer. Because patients with early-stage bladder transitional cell carcinoma (TCC) often have a long survival, we considered whether they would constitute a suitable population for a screening study.
Patients with Ta/is/1 N0 M0 TCC of the bladder and no history of previous cancer treated surgically between 1983 and 2002 were studied using the Surveillance, Epidemiology, and End Results (SEER) database. The incidence and cancer-specific mortality of second nonurothelial solid organ cancers was determined. The standardized incidence ratio (SIR) and 15-year actuarial incidences were determined.
From 1983 to 2002, 8300 patients meeting the inclusion criteria were entered into the SEER-9 Registry. Among them, the SIR for a second solid organ malignancy was 1.25 (95% CI, 1.18-1.32). The SIR was significantly increased for tumors of the lung (1.71), head and neck (1.32), and prostate (1.28). The 15-year incidence of and mortality from lung cancer were 8.8% and 8.6%, respectively. Among all nonurothelial second malignancies, lung cancers accounted for 32.5% of the incidence and 53.4% of cancer-specific deaths. Moreover, lung cancer accounted for 12.2% of overall deaths in these patients.
Patients with non-muscle-invasive bladder TCC suffer a high incidence of mortality from lung cancer and might constitute a suitable population for a lung screening trial. Other tobacco-related health events might add to smoking history in identifying high-risk populations.
肺癌筛查试验依赖于足够高危人群的选择。由于并非所有吸烟者都会患癌症，我们推测有烟草相关恶性肿瘤病史可能更可靠地预测后续肺癌。由于早期膀胱移行细胞癌（TCC）患者通常生存期较长，我们考虑他们是否会构成适合筛查研究的人群。
使用监测、流行病学和最终结果（SEER）数据库研究了1983年至2002年间患有Ta/is/1 N0 M0膀胱TCC且无既往手术治疗癌症史的患者。确定了第二种非尿路上皮实体器官癌症的发病率和癌症特异性死亡率。确定了标准化发病率（SIR）和15年精算发病率。
1983年至2002年，8300名符合纳入标准的患者进入SEER - 9登记处。其中，第二种实体器官恶性肿瘤的SIR为1.25（95%CI，1.18 - 1.32）。肺癌（1.71）、头颈癌（1.32）和前列腺癌（1.28）的SIR显著升高。肺癌的15年发病率和死亡率分别为8.8%和8.6%。在所有非尿路上皮第二种恶性肿瘤中，肺癌占发病率的32.5%和癌症特异性死亡的53.4%。此外，肺癌占这些患者总死亡人数的12.2%。
非肌层浸润性膀胱TCC患者肺癌死亡率高，可能构成适合肺癌筛查试验的人群。在识别高危人群时，其他与烟草相关的健康事件可能会补充吸烟史。
