Morais Samantha, Antunes Luís, Bento Maria J, Lunet Nuno
EPIUnit, Instituto de Saúde Pública, Universidade do Porto.
Serviço de Epidemiologia, Instituto Português de Oncologia do Porto.
Eur J Gastroenterol Hepatol. 2019 Apr;31(4):471-477. doi: 10.1097/MEG.0000000000001348.
Gastric first primary cancers (FPCs) have an increased risk of developing second primary cancers (SPCs). However, their effect on mortality remains poorly understood. Thus, we aimed to estimate the contribution of SPCs to the mortality of gastric FPCs.
A population-based cohort of gastric FPCs diagnosed in 2000-2006 was followed for SPCs (31 December 2012) and vital status (31 December 2017). SPCs (138 synchronous and 205 metachronous, ≤1 and >1 year after the FPC, respectively) were matched (1 : 3, by sex, 5-year age group, and year of FPC diagnosis) with those without an SPC and alive when the corresponding SPC was diagnosed.
In synchronous SPCs, the hazard ratio (95% confidence interval) for death was 1.07 (0.81-1.40) in males and 0.86 (0.58-1.28) in females; the corresponding estimates for metachronous SPCs were 1.89 (1.49-2.41) and 2.08 (1.42-3.05). In synchronous SPCs, the 10-year cumulative mortality was similar to that of FPCs only; the estimates were higher in lung SPCs. The 10-year cumulative mortality was 75.5% in males and 65.5% in females with metachronous SPCs, which is more than 20% higher than for FPCs only.
Among patients with gastric FPCs who survive long enough for metachronous SPCs, the latter substantially increases mortality over 10 years, whereas the effect of synchronous SPCs is generally smaller.
胃原发性第一癌（FPC）发生第二原发性癌（SPC）的风险增加。然而，它们对死亡率的影响仍知之甚少。因此，我们旨在评估SPC对胃FPC死亡率的影响。
对2000年至2006年诊断的基于人群的胃FPC队列进行随访，观察SPC（截至2012年12月31日）和生命状态（截至2017年12月31日）。SPC（138例同时性和205例异时性，分别在FPC后≤1年和>1年）与未发生SPC且在相应SPC诊断时存活的患者进行匹配（按性别、5岁年龄组和FPC诊断年份1∶3匹配）。
在同时性SPC中，男性死亡风险比（95%置信区间）为1.07（0.81 - 1.40），女性为0.86（0.58 - 1.28）；异时性SPC的相应估计值为1.89（1.49 - 2.41）和2.08（1.42 - 3.05）。在同时性SPC中，10年累积死亡率与仅患FPC者相似；肺部SPC的估计值更高。异时性SPC的男性10年累积死亡率为75.5%，女性为65.5%，比仅患FPC者高出20%以上。
在胃FPC患者中，那些存活时间足够长以发生异时性SPC的患者，异时性SPC在10年内会显著增加死亡率，而同时性SPC的影响通常较小。
