University of Connecticut, Internal Medicine, Hartford, CT 06103, USA.
Curr Med Res Opin. 2013 Sep;29(9):1055-65. doi: 10.1185/03007995.2013.816276. Epub 2013 Jul 9.
Development of a second primary malignancy (SPM) after an index esophageal cancer is fairly rare, primarily due to decreased survival in patients with esophageal cancer. However, with advances in early detection and therapy, the number of long-term survivors is increasing, as is the incidence of SPMs in this population.
We review herein the published literature on the incidence of SPMs after an index esophageal cancer as well as its associated risk factors, prognosis and surveillance. We discuss predisposing factors that may contribute to the development of SPMs, epidemiology and attempts at chemoprevention.
Data from population-based studies, retrospective reviews and case reports indicate an increased risk of SPMs in patients with esophageal cancer with reported incidence rates between 8.3 and 27.1%. Index esophageal squamous cell carcinomas have a higher association with other tobacco-related cancers such as those of the head and neck and lung. They have also shown an association with second primary cancers of the breast, stomach, thyroid, and kidney. Individuals with esophageal adenocarcinomas are at a higher risk of developing second cancers of the stomach, oropharynx and lung/bronchus. Other primary cancer sites involved include the kidney, colorectum and pancreas. Common risk factors including lifestyle and genetic alterations may explain the increased incidence of second primary cancers in this patient population.
Risk of developing a second malignancy should be anticipated after curative treatment of esophageal cancer, and raises concerns for optimal surveillance and therapy of these patients. Recent literature suggests similar survival rates in esophageal cancer patients with and without SPMs. With the increasing incidence of SPMs in subjects with esophageal cancer, there may be benefit to close screening for and aggressive therapy of SPMs. However, further studies are needed to elucidate optimal management strategies.
在原发性食管癌之后发展为第二原发性恶性肿瘤（SPM）相当罕见，主要是因为食管癌患者的生存率降低。然而，随着早期检测和治疗的进步，长期存活者的数量正在增加，该人群中 SPM 的发病率也在增加。
我们在此回顾了关于原发性食管癌后 SPM 发生率及其相关危险因素、预后和监测的已发表文献。我们讨论了可能导致 SPM 发展的易患因素、流行病学和化学预防尝试。
来自基于人群的研究、回顾性研究和病例报告的数据表明，食管癌患者发生 SPM 的风险增加，报告的发病率在 8.3%至 27.1%之间。原发性食管鳞状细胞癌与其他与烟草相关的癌症（如头颈部和肺癌）的关联更高。它们还与乳腺癌、胃癌、甲状腺癌和肾癌等第二原发癌有关。患有食管腺癌的个体发生胃癌、口咽癌和肺/支气管癌的风险更高。涉及的其他原发性癌症部位包括肾脏、结肠直肠和胰腺。包括生活方式和遗传改变在内的常见危险因素可能解释了该患者人群中第二原发癌发病率的增加。
在根治性治疗食管癌后应预料到发生第二恶性肿瘤的风险，并对这些患者的最佳监测和治疗提出关注。最近的文献表明，有和没有 SPM 的食管癌患者的生存率相似。随着食管癌患者中 SPM 的发病率增加，对 SPM 的密切筛查和积极治疗可能会带来益处。然而，需要进一步的研究来阐明最佳管理策略。
