直肠癌根治术后是否行放疗的继发恶性肿瘤：基于倾向评分匹配的人群 SEER 分析。

Secondary malignancies after rectal cancer resection with and without radiation therapy: A propensity-adjusted, population-based SEER analysis.

机构信息

Department of Surgery, Cantonal Hospital, St.Gallen, Switzerland; Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.

Department of Medical Oncology and Hematology, Cantonal Hospital, St.Gallen, Switzerland; Department of Visceral Surgery and Medicine, University of Berne, Switzerland.

出版信息

Radiother Oncol. 2017 Apr;123(1):139-146. doi: 10.1016/j.radonc.2017.02.007. Epub 2017 Mar 9.

DOI:10.1016/j.radonc.2017.02.007

PMID:28285840

Abstract

BACKGROUND

The relationship between radiation therapy for rectal cancer and secondary malignancies is debated. The present study is the first population-based analysis using conventional multivariable analyses as well as propensity score matching to assess this relationship.

METHODS

Overall, 77,484 patients after resection of localized or locally advanced rectal adenocarcinoma diagnosed between 1973 and 2012 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry. The occurrence of secondary malignancies diagnosed at least 1 (median follow up 5.8years [1-39.9years]) year after rectal cancer diagnosis was compared in patients who did and did not undergo radiation using stratified and propensity score matched Cox regression analysis.

RESULTS

Of 77,484 patients, 34,114 underwent radiation and 43,370 did not. Ignoring gender and entity, radiation therapy was not associated with secondary malignancies (hazard ratio [HR]=0.97 (95%CI: 0.92-1.02, P=0.269). The risk for prostate cancer was decreased and (HR=0.42, 95%CI: 0.36-0.48, P<0.001) and increased risk for endometrial cancer (HR=1.95, 95%CI: 1.49-2.56, P<0.001). Overall, patients undergoing radiation had higher risks for lung cancer (HR=1.18, 95%CI: 1.06-1.30, P<0.001), bladder cancer (HR=1.54, 95%CI: 1.31-1.80, P<0.001) and lymphomas (HR=1.27, 95%CI: 1.03-1.58, P=0.026).

CONCLUSIONS

The present analysis describes the occurence of secondary malignancies after pelvic radiation in patients undergoing rectal cancer surgery. Indeed, radiation for rectal cancer is associated with a significantly decreased risk of prostate cancer, however, an increased risk of endometrial, lung, and bladder cancer as well as lymphomas was observed. Overall, the risk of secondary malignancies was slightly decreased with radiation in patients undergoing rectal cancer resection, this was attributable to lower rates in prostate cancer.

摘要

背景

直肠癌放射治疗与继发恶性肿瘤之间的关系存在争议。本研究首次利用常规多变量分析和倾向评分匹配来评估这种关系，对人群进行了分析。

方法

本研究共纳入了 1973 年至 2012 年间在监测、流行病学和最终结果（SEER）登记处诊断为局限性或局部晚期直肠腺癌切除后的 77484 例患者。在直肠癌诊断后至少 1 年（中位随访时间为 5.8 年[1-39.9 年]）确诊继发性恶性肿瘤的患者中，比较了接受和未接受放射治疗的患者的发病情况，使用分层和倾向评分匹配的 Cox 回归分析。

结果

在 77484 例患者中，34114 例患者接受了放射治疗，43370 例患者未接受放射治疗。忽略性别和实体肿瘤，放射治疗与继发性恶性肿瘤无关（风险比[HR]=0.97（95%CI：0.92-1.02，P=0.269）。前列腺癌的风险降低（HR=0.42，95%CI：0.36-0.48，P<0.001），子宫内膜癌的风险增加（HR=1.95，95%CI：1.49-2.56，P<0.001）。总体而言，接受放射治疗的患者肺癌（HR=1.18，95%CI：1.06-1.30，P<0.001）、膀胱癌（HR=1.54，95%CI：1.31-1.80，P<0.001）和淋巴瘤（HR=1.27，95%CI：1.03-1.58，P=0.026）的风险更高。