Department of Information Sciences, City of Hope, Duarte, California.
Department of Surgery, City of Hope, Duarte, California.
Cancer. 2017 Oct 15;123(20):4013-4021. doi: 10.1002/cncr.30828. Epub 2017 Jun 13.
Over the last decade, the causal link between human papillomavirus (HPV) infection and squamous cell carcinoma of the anus (SCCA) has been well described. Because HPV infection in one site is often associated with other sites of infection, it then follows that patients with SCCA may have an increased risk of additional HPV-related cancers. Identifying and targeting at-risk sites through cancer screening and surveillance may help to guide best practices. The current study sought to ascertain sites and risk of HPV-related second primary malignancies (SPMs) in survivors of SCCA.
Using population-based data from 1992 through 2012, the authors identified patients with SCCA and determined their risk of HPV-related SPMs, including anal, oral, and genital cancers. Standardized incidence ratios (SIRs), defined as observed to expected cases, were calculated to determine excess risk.
Of 10,537 patients with SCCA, 416 developed HPV-related SPMs, which corresponded to an overall SIR of 21.5 (99% confidence interval [99% CI], 19.0-24.2). Men were found to have a higher SIR (35.8; 99% CI, 30.7-41.6) compared with women (12.8; 99% CI, 10.4-15.5). SIRs for a second SCCA were markedly higher in men (127.5; 99% CI, 108.1-149.2) compared with women (47.0; 99% CI, 34.7-62.1), whereas SIRs for oral cavity and pharyngeal cancers were elevated in men (3.1; 99% CI, 1.5-5.7) and women (4.4; 99% CI, 1.5-9.7). SIRs for sex-specific sites also were elevated, with male genital cancers having an SIR of 19.6 (99% CI, 8.7-37.6) and female genital cancers an SIR of 8.3 (99% CI, 6.1-11.0).
Patients with index SCCA are at an increased risk of subsequent HPV-related SPMs. The elevated risk is most striking in patients with second primary SCCAs; however, the risk of second cancers also appears to be increased in other HPV-related sites. Cancer 2017;123:4013-21. © 2017 American Cancer Society.
在过去的十年中，人乳头瘤病毒（HPV）感染与肛门鳞状细胞癌（SCCA）之间的因果关系已得到充分描述。由于一个部位的 HPV 感染通常与其他部位的感染有关，因此可以推断 SCCA 患者可能有更高的罹患其他 HPV 相关癌症的风险。通过癌症筛查和监测来识别和定位高危部位，可能有助于指导最佳实践。本研究旨在确定 SCCA 幸存者的 HPV 相关第二原发恶性肿瘤（SPM）的部位和风险。
作者使用 1992 年至 2012 年的基于人群的数据，确定了 SCCA 患者，并确定了他们罹患 HPV 相关 SPM 的风险，包括肛门、口腔和生殖器癌症。标准化发病率比（SIR）定义为观察到的病例与预期病例的比值，用于确定超额风险。
在 10537 例 SCCA 患者中，有 416 例发生了 HPV 相关 SPM，这对应于总体 SIR 为 21.5（99%置信区间[99%CI]，19.0-24.2）。与女性（12.8；99%CI，10.4-15.5）相比，男性的 SIR 更高（35.8；99%CI，30.7-41.6）。男性第二 SCCA 的 SIR 明显更高（127.5；99%CI，108.1-149.2），而女性的 SIR 则更低（47.0；99%CI，34.7-62.1），而男性口腔和咽癌的 SIR 升高（3.1；99%CI，1.5-5.7）和女性（4.4；99%CI，1.5-9.7）。特定部位的 SIR 也升高，男性生殖器癌症的 SIR 为 19.6（99%CI，8.7-37.6），女性生殖器癌症的 SIR 为 8.3（99%CI，6.1-11.0）。
患有指数 SCCA 的患者罹患后续 HPV 相关 SPM 的风险增加。在患有第二原发 SCCA 的患者中，风险最为显著；然而，其他 HPV 相关部位的第二癌风险似乎也有所增加。癌症 2017；123：4013-21。©2017 美国癌症协会。
