睾丸癌放疗后胰腺癌风险增加。
Increased pancreatic cancer risk following radiotherapy for testicular cancer.
作者信息
Hauptmann Michael, Børge Johannesen Tom, Gilbert Ethel S, Stovall Marilyn, van Leeuwen Flora E, Rajaraman Preetha, Smith Susan A, Weathers Rita E, Aleman Berthe M P, Andersson Michael, Curtis Rochelle E, Dores Graça M, Fraumeni Joseph F, Hall Per, Holowaty Eric J, Joensuu Heikki, Kaijser Magnus, Kleinerman Ruth A, Langmark Frøydis, Lynch Charles F, Pukkala Eero, Storm Hans H, Vaalavirta Leila, van den Belt-Dusebout Alexandra W, Morton Lindsay M, Fossa Sophie D, Travis Lois B
机构信息
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Cancer Registry of Norway, Oslo, Norway.
出版信息
Br J Cancer. 2016 Sep 27;115(7):901-8. doi: 10.1038/bjc.2016.272. Epub 2016 Sep 6.
BACKGROUND
Pancreatic cancer risk is elevated among testicular cancer (TC) survivors. However, the roles of specific treatments are unclear.
METHODS
Among 23 982 5-year TC survivors diagnosed during 1947-1991, doses from radiotherapy to the pancreas were estimated for 80 pancreatic cancer patients and 145 matched controls. Chemotherapy details were recorded. Logistic regression was used to estimate odds ratios (ORs).
RESULTS
Cumulative incidence of second primary pancreatic cancer was 1.1% at 30 years after TC diagnosis. Radiotherapy (72 (90%) cases and 115 (80%) controls) was associated with a 2.9-fold (95% confidence interval (CI) 1.0-7.8) increased risk. The OR increased linearly by 0.12 per Gy to the pancreas (P-trend<0.001), with an OR of 4.6 (95% CI 1.9-11.0) for ⩾25 Gy vs <25 Gy. Radiation-related risks remained elevated ⩾20 years after TC diagnosis (P=0.020). The risk increased with the number of cycles of chemotherapy with alkylating or platinum agents (P=0.057), although only one case was exposed to platinum.
CONCLUSIONS
A dose-response relationship exists between radiation to the pancreas and subsequent cancer risk, and persists for over 20 years. These excesses, although small, should be considered when radiotherapy with exposure to the pancreas is considered for newly diagnosed patients. Additional data are needed on the role of chemotherapy.
背景
睾丸癌（TC）幸存者患胰腺癌的风险升高。然而，具体治疗方法的作用尚不清楚。
方法
在1947年至1991年期间诊断出的23982名5年TC幸存者中，估计了80例胰腺癌患者和145例匹配对照接受胰腺放疗的剂量。记录了化疗细节。采用逻辑回归估计比值比（OR）。
结果
TC诊断后30年，第二原发性胰腺癌的累积发病率为1.1%。放疗（72例（90%）患者和115例（80%）对照）与风险增加2.9倍（95%置信区间（CI）1.0 - 7.8）相关。胰腺接受的辐射剂量每增加1戈瑞，OR线性增加0.12（P趋势<0.001），胰腺接受≥25戈瑞辐射的OR为4.6（95%CI 1.9 - 11.0），而接受<25戈瑞辐射的OR为1.0。TC诊断后≥20年，与辐射相关的风险仍然升高（P = 0.020）。使用烷化剂或铂类药物化疗的周期数增加，风险也增加（P = 0.057），尽管只有1例患者接受了铂类药物治疗。
结论
胰腺辐射与后续癌症风险之间存在剂量反应关系，且持续超过20年。对于新诊断的患者，在考虑对胰腺有照射的放疗时，应考虑这些额外风险，尽管风险较小。关于化疗的作用还需要更多数据。
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