Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
J Clin Oncol. 2011 Dec 1;29(34):4510-5. doi: 10.1200/JCO.2011.35.0991. Epub 2011 Oct 24.
To assess the risk of second primary cancer (SPC) after [(125)I]iodine prostate cancer brachytherapy compared with prostatectomy and the general population.
In a cohort consisting of 1,888 patients with prostate cancer who received monotherapy with brachytherapy (n = 1,187; 63%) or prostatectomy (n = 701; 37%), SPC incidences were retrieved by linkage with the Dutch Cancer Registry. Standardized incidence rates (SIRs) and absolute excess risks (AERs) were calculated for comparison.
A total of 223 patients were diagnosed with SPC, 136 (11%) after brachytherapy and 87 (12%) after prostatectomy, with a median follow-up of 7.5 years. The SIR for all malignancies, bladder cancer, and rectal cancer were 0.94 (95% CI, 0.78 to 1.12), 1.69 (95% CI, 0.98 to 2.70), and 0.90 (95% CI, 0.41 to 1.72) for brachytherapy and 1.04 (95% CI, 0.83 to 2.28), 1.82 (95% CI, 0.87 to 3.35), and 1.50 (95% CI, 0.68 to 2.85) for prostatectomy, respectively. Bladder SPC risk was significantly increased after brachytherapy for patients age 60 years or younger (SIR, 5.84; 95% CI, 2.14 to 12.71; AER, 24.03) and in the first 4 years of follow-up (SIR, 2.14; 95% CI, 1.03 to 3.94; AER, 12.24). Adjusted for age, the hazard ratio (brachytherapy v prostatectomy) for all SPCs combined was 0.87 (95% CI, 0.64 to 1.18).
Overall, we found no difference in SPC incidence between patients with prostate cancer treated with prostatectomy or brachytherapy. Furthermore, no increased tumor incidence was found compared with the general population. We observed a higher than expected incidence of bladder SPC after brachytherapy in the first 4 years of follow-up, probably resulting from lead time or screening bias. Because of power limitations, a small increased SPC risk cannot be formally excluded.
评估与前列腺切除术和普通人群相比，[(125)I]碘前列腺癌近距离放射治疗后发生第二原发癌（SPC）的风险。
在由 1888 例接受单纯近距离放射治疗（n=1187；63%）或前列腺切除术（n=701；37%）治疗的前列腺癌患者组成的队列中，通过与荷兰癌症登记处的链接检索 SPC 发生率。计算标准化发病率比（SIRs）和绝对超额风险（AERs）以进行比较。
共有 223 例患者被诊断为 SPC，136 例（11%）发生在近距离放射治疗后，87 例（12%）发生在前列腺切除术后，中位随访时间为 7.5 年。所有恶性肿瘤、膀胱癌和直肠癌的 SIR 分别为 0.94（95%CI，0.78 至 1.12）、1.69（95%CI，0.98 至 2.70）和 0.90（95%CI，0.41 至 1.72）在近距离放射治疗中，1.04（95%CI，0.83 至 2.28）、1.82（95%CI，0.87 至 3.35）和 1.50（95%CI，0.68 至 2.85）在前列腺切除术中。60 岁或以下的近距离放射治疗患者的膀胱癌 SPC 风险显著增加（SIR，5.84；95%CI，2.14 至 12.71；AER，24.03），且在随访的前 4 年内（SIR，2.14；95%CI，1.03 至 3.94；AER，12.24）。调整年龄后，所有 SPC 联合的危险比（近距离放射治疗与前列腺切除术）为 0.87（95%CI，0.64 至 1.18）。
总体而言，我们发现接受前列腺切除术或近距离放射治疗的前列腺癌患者的 SPC 发生率没有差异。此外，与普通人群相比，未发现肿瘤发生率增加。我们在随访的前 4 年内观察到近距离放射治疗后膀胱癌 SPC 的发生率高于预期，可能是由于领先时间或筛查偏倚所致。由于受限于研究的效能，我们无法正式排除 SPC 风险略有增加的可能性。
