Yang Jiao, Li Shuting, Lv Meng, Wu Yinying, Chen Zheling, Shen Yanwei, Wang Biyuan, Chen Ling, Yi Min, Yang Jin
Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China.
Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China; Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Onco Targets Ther. 2017 Mar 13;10:1535-1548. doi: 10.2147/OTT.S129220. eCollection 2017.
The site-distribution pattern and relative risk of subsequent primary malignancies (SPMs) in colorectal cancer (CRC) patients remains to be determined.
A population-based cohort of 288,390 CRC patients diagnosed between 1973 and 2012 from the Surveillance, Epidemiology, and End Results database was retrospectively reviewed. Standardized incidence ratios were calculated to estimate the relative risk for SPMs.
The overall risk of SPMs increased in CRC patients (standardized incidence ratio 1.02) in the first 5 years after CRC diagnosis compared with that in the general population, and was negatively related to age at diagnosis. Risk increased significantly for cancers of the small intestine, ureter, colorectum, renal pelvis, endocrine system, and stomach, and decreased significantly for cancers of the gallbladder, liver, myeloma, and brain, as well as lymphoma. Patients with different prior CRC subsites showed specific sites at high risk of SPM. Prior right-sided colon cancer was associated with cancers of the small intestine, ureter, renal pelvis, thyroid, stomach, pancreas, and breast and prior left-sided colon cancer associated with secondary CRC, whereas rectal cancer was associated with cancers of the vagina, urinary bladder, and lung.
Risk of SPMs increases in CRC survivors, especially in the first 5 years after prior diagnosis. Intensive surveillance should be advocated among young patients, with specific attention to the small intestine, colorectum, renal pelvis, and ureter. The common sites at high risk of SPM originate from the embryonic endoderm. Genetic susceptibility may act as the main mechanism underlying the risk of multiple cancers.
结直肠癌（CRC）患者后续原发性恶性肿瘤（SPM）的部位分布模式及相对风险仍有待确定。
回顾性分析了监测、流行病学和最终结果数据库中1973年至2012年间诊断的288390例CRC患者的基于人群的队列。计算标准化发病比以估计SPM的相对风险。
与普通人群相比，CRC患者在CRC诊断后的前5年中SPM的总体风险增加（标准化发病比为1.02），且与诊断时的年龄呈负相关。小肠、输尿管、结肠、肾盂、内分泌系统和胃癌的风险显著增加，而胆囊、肝脏、骨髓瘤、脑癌以及淋巴瘤的风险显著降低。不同先前CRC亚部位的患者显示出SPM高风险的特定部位。先前右侧结肠癌与小肠、输尿管、肾盂、甲状腺、胃、胰腺和乳腺癌相关，先前左侧结肠癌与继发性CRC相关，而直肠癌与阴道、膀胱和肺癌相关。
CRC幸存者中SPM的风险增加，尤其是在先前诊断后的前5年。应提倡对年轻患者进行强化监测，特别关注小肠、结肠、肾盂和输尿管。SPM高风险的常见部位起源于胚胎内胚层。遗传易感性可能是多种癌症风险的主要潜在机制。
