奥地利西部各州第二原发癌的相对风险：一项回顾性队列研究。
The relative risk of second primary cancers in Austria's western states: a retrospective cohort study.
机构信息
Agency for Preventive and Social Medicine, Bregenz, Vorarlberg, Austria.
Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Innsbruck, Austria.
出版信息
BMC Cancer. 2017 Oct 24;17(1):699. doi: 10.1186/s12885-017-3683-9.
BACKGROUND
Cancer survivors are at risk of developing a second primary cancer (SPC) later in life because of persisting effects of genetic and behavioural risk factors, the long-term sequelae of chemotherapy, radiotherapy and the passage of time. This is the first study with Austrian data on an array of entities, estimating the risk of SPCs in a population-based study by calculating standardized incidence ratios (SIRs).
METHODS
This retrospective cohort study included all invasive incident cancer cases diagnosed within the years 1988 to 2005 being registered in the Tyrol and Vorarlberg Cancer Registries. Person years at risk (PYAR) were calculated from time of first diagnosis plus 2 months until the exit date, defined as the date of diagnosis of the SPC, date of death, or end of 2010, whichever came first. SIR for specific SPCs was calculated based on the risk of these patients for this specific cancer.
RESULTS
A total of 59,638 patients were diagnosed with cancer between 1988 and 2005 and 4949 SPCs were observed in 399,535 person-years of follow-up (median 5.7 years). Overall, neither males (SIR 0.90; 95% CI 0.86-0.93) nor females (SIR 1.00; 95% CI 0.96-1.05) had a significantly increased SIR of developing a SPC. The SIR for SPC decreased with age showing a SIR of 1.24 (95% CI 1.12-1.35) in the age group of 15-49 and a SIR of 0.85 (95% CI 0.82-0.89) in the age group of ≥ 65. If the site of the first primary cancer was head/neck/larynx cancer in males and females (SIR 1.88, 95% CI 1.67-2.11 and 1.74, 95% CI 1.30-2.28), cervix cancer in females (SIR 1.40, 95% CI 1.14-1.70), bladder cancer in males (SIR 1.20, 95% CI 1.07-1.34), kidney cancer in males and females (SIR 1.22, 95% 1.04-1.42 and 1.29, 95% CI 1.03-1.59), thyroid gland cancer in females (SIR 1.40, 95% CI 1.11-1.75), patients showed elevated SIR, developing a SPC.
CONCLUSIONS
Survivors of head & neck, bladder/kidney, thyroid cancer and younger patients show elevated SIRs, developing a SPC. This has possible implications for surveillance strategies.
背景
由于遗传和行为风险因素的持续影响、化疗、放疗的长期后果以及时间的推移，癌症幸存者在以后的生活中罹患第二原发癌（SPC）的风险增加。这是第一项使用奥地利数据的研究，通过计算标准化发病比（SIR）来估计基于人群的研究中 SPC 的风险。
方法
这项回顾性队列研究包括 1988 年至 2005 年期间在蒂罗尔州和福拉尔贝格癌症登记处登记的所有浸润性首发癌症病例。风险人年（PYAR）从首次诊断加 2 个月开始计算，直到退出日期，定义为 SPC 的诊断日期、死亡日期或 2010 年底，以先到者为准。特定 SPC 的 SIR 是根据这些患者患特定癌症的风险计算的。
结果
1988 年至 2005 年间共诊断出 59638 例癌症患者，在 399535 人年的随访中观察到 4949 例 SPC（中位数 5.7 年）。总体而言，男性（SIR 0.90；95%CI 0.86-0.93）和女性（SIR 1.00；95%CI 0.96-1.05）均未显示 SPC 发病的 SIR 显著增加。SPC 的 SIR 随年龄而降低，15-49 岁年龄组的 SIR 为 1.24（95%CI 1.12-1.35），≥65 岁年龄组的 SIR 为 0.85（95%CI 0.82-0.89）。如果男性和女性的第一原发癌部位为头/颈/喉癌（SIR 1.88，95%CI 1.67-2.11 和 1.74，95%CI 1.30-2.28）、女性宫颈癌（SIR 1.40，95%CI 1.14-1.70）、男性膀胱癌（SIR 1.20，95%CI 1.07-1.34）、男性和女性肾癌（SIR 1.22，95%CI 1.04-1.42 和 1.29，95%CI 1.03-1.59）、女性甲状腺癌（SIR 1.40，95%CI 1.11-1.75），则患者出现 SPC 的 SIR 升高。
结论
头颈部、膀胱/肾脏、甲状腺癌幸存者和年轻患者的 SIR 升高，出现 SPC。这可能对监测策略有影响。
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