Jo Jung Hyun, Cho In Rae, Jung Jang Han, Lee Hee Seung, Chung Moon Jae, Bang Seungmin, Park Seung Woo, Chung Jae Bock, Song Si Young, Park Jeong Youp
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2017 Jun 26;12(6):e0179784. doi: 10.1371/journal.pone.0179784. eCollection 2017.
Several studies reported the increased risk of second primary pancreatic ductal adenocarcinoma (2nd PDAC) in cancer survivors. However, data on the characteristics of 2nd PDAC are insufficient.
This retrospective cohort study included 1759 patients with PDAC. They were classified as having 2nd PDAC or first primary PDAC (1st PDAC) according to a prior diagnosed cancer of different origin, at least 6 months before PDAC diagnosis.
There were 110 patients (6.4%) with 2nd PDAC and 1606 (93.6%) patients with 1st PDAC. Patients with 2nd PDAC presented with older age (66.5 vs. 62.2 years, p < 0.001) and higher rate of resectability (26.4% vs. 15.9%, p = 0.004) at diagnosis than those with 1st PDAC. Multivariate analysis without considering resectable status showed that 2nd PDAC (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56-0.94, p = 0.016) was associated with better overall survival. After adjusting for resectable status, however, 2nd PDAC (HR 0.85, 95% CI 0.66-1.09, p = 0.198) was no longer associated with overall survival. When subgroups were separately analyzed according to initial treatment modality, the effectiveness of surgery and chemotherapy were similar between 2nd and 1st PDAC (33.1 vs. 28.5 months, p = 0.860 and 10.8 vs. 10.7 months, p = 0.952).
The proportion of resectable cases was significantly higher in 2nd PDAC. When surgery with curative aim was possible, the overall survival was increased even in patients with 2nd PDAC. These results suggest the importance of screening for second primary cancer in cancer survivors.
多项研究报告了癌症幸存者发生第二原发性胰腺导管腺癌（2nd PDAC）的风险增加。然而，关于2nd PDAC特征的数据并不充分。
这项回顾性队列研究纳入了1759例胰腺导管腺癌患者。根据在胰腺导管腺癌诊断前至少6个月确诊的不同起源的既往癌症，将他们分为患有2nd PDAC或第一原发性胰腺导管腺癌（1st PDAC）。
有110例（6.4%）患者患有2nd PDAC，1606例（93.6%）患者患有1st PDAC。2nd PDAC患者在诊断时的年龄比1st PDAC患者更大（66.5岁对62.2岁，p<0.001），可切除率更高（26.4%对15.9%，p = 0.004）。不考虑可切除状态的多变量分析显示，2nd PDAC（风险比[HR] 0.73，95 %置信区间[CI] 0.56 - 0.94，p = 0.016）与更好的总生存期相关。然而，在调整可切除状态后，2nd PDAC（HR 0.85，95 % CI 0.66 - 1.09，p = 0.198）不再与总生存期相关。当根据初始治疗方式分别分析亚组时，2nd PDAC和1st PDAC之间手术和化疗的有效性相似（33.1个月对28.5个月，p = 0.860；10.8个月对10.7个月，p = 0.952）。
2nd PDAC中可切除病例的比例显著更高。当有可能进行根治性手术时，即使是2nd PDAC患者的总生存期也会增加。这些结果表明在癌症幸存者中筛查第二原发性癌症的重要性。
