Murphy James D, Ma Grace L, Baumgartner Joel M, Madlensky Lisa, Burgoyne Adam M, Tang Chih-Min, Martinez Maria Elena, Sicklick Jason K
Department of Radiation and Applied Sciences, Moores Cancer Center, University of California San Diego, La Jolla, California.
Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California.
Cancer. 2015 Sep 1;121(17):2960-7. doi: 10.1002/cncr.29434. Epub 2015 Apr 30.
Most gastrointestinal stromal tumors (GISTs) are considered nonhereditary or sporadic. However, single-institution studies suggest that GIST patients develop additional malignancies at increased frequencies. It was hypothesized that greater insight could be gained into possible associations between GISTs and other malignancies with a national cancer database inquiry.
Patients diagnosed with GISTs (2001-2011) in the Surveillance, Epidemiology, and End Results database were included. Standardized prevalence ratios (SPRs) and standardized incidence ratios (SIRs) were used to quantify cancer risks incurred by GIST patients before and after GIST diagnoses, respectively, in comparison with the general US population.
There were 6112 GIST patients, and 1047 (17.1%) had additional cancers. There were significant increases in overall cancer rates: 44% (SPR, 1.44) before the GIST diagnosis and 66% (SIR, 1.66) after the GIST diagnosis. Malignancies with significantly increased occurrence both before and after diagnoses included other sarcomas (SPR, 5.24; SIR, 4.02), neuroendocrine-carcinoid tumors (SPR, 3.56; SIR, 4.79), non-Hodgkin lymphoma (SPR, 1.69; SIR, 1.76), and colorectal adenocarcinoma (SPR, 1.51; SIR, 2.16). Esophageal adenocarcinoma (SPR, 12.0), bladder adenocarcinoma (SPR, 7.51), melanoma (SPR, 1.46), and prostate adenocarcinoma (SPR, 1.20) were significantly more common only before the GIST diagnosis. Ovarian carcinoma (SIR, 8.72), small intestine adenocarcinoma (SIR, 5.89), papillary thyroid cancer (SIR, 5.16), renal cell carcinoma (SIR, 4.46), hepatobiliary adenocarcinoma (SIR, 3.10), gastric adenocarcinoma (SIR, 2.70), pancreatic adenocarcinoma (SIR, 2.03), uterine adenocarcinoma (SIR, 1.96), non-small cell lung cancer (SIR, 1.74), and transitional cell carcinoma of the bladder (SIR, 1.65) were significantly more common only after the GIST diagnosis.
This is the first population-based study to characterize the associations and temporal relations between GISTs and other cancers by both site and histological type. These associations may carry important clinical implications for future cancer screening and treatment strategies.
大多数胃肠道间质瘤（GIST）被认为是非遗传性或散发性的。然而，单机构研究表明，GIST患者发生其他恶性肿瘤的频率增加。据推测，通过全国癌症数据库查询，可能会更深入了解GIST与其他恶性肿瘤之间的潜在关联。
纳入监测、流行病学和最终结果数据库中2001年至2011年诊断为GIST的患者。标准化患病率比（SPR）和标准化发病率比（SIR）分别用于量化GIST患者在GIST诊断前后与美国普通人群相比所面临的癌症风险。
共有6112例GIST患者，其中1047例（17.1%）患有其他癌症。总体癌症发生率显著增加：GIST诊断前为44%（SPR，1.44），诊断后为66%（SIR，1.66）。诊断前后发生率均显著增加的恶性肿瘤包括其他肉瘤（SPR，5.24；SIR，4.02）、神经内分泌类癌肿瘤（SPR，3.56；SIR，4.79）、非霍奇金淋巴瘤（SPR，1.69；SIR，1.76）和结肠腺癌（SPR，1.51；SIR，2.1）。食管腺癌（SPR，12.0）、膀胱腺癌（SPR，7.51）、黑色素瘤（SPR，1.46）和前列腺腺癌（SPR，1.20）仅在GIST诊断前显著更常见。卵巢癌（SIR，8.72）、小肠腺癌（SIR，5.89）、甲状腺乳头状癌（SIR，5.16）、肾细胞癌（SIR，4.46）、肝胆腺癌（SIR，3.10）、胃腺癌（SIR，2.70）、胰腺腺癌（SIR，2.03）、子宫腺癌（SIR，1.96）、非小细胞肺癌（SIR，1.74）和膀胱移行细胞癌（SIR，1.65）仅在GIST诊断后显著更常见。
这是第一项基于人群的研究，按部位和组织学类型描述GIST与其他癌症之间的关联和时间关系。这些关联可能对未来的癌症筛查和治疗策略具有重要的临床意义。
