Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
Int J Cancer. 2019 Jul 1;145(1):143-153. doi: 10.1002/ijc.32101. Epub 2019 Jan 24.
While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking-related cancers. The current study was a population-based study of patients diagnosed with a primary malignancy from the top 10 smoking-related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking-related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50-1.52) and the EAR was 73.3 cases per 10,000 PYR compared to the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR = 2.06) and urinary bladder cancer had the highest excess burden (EAR = 151.4 per 10,000 PYR). The excess burden of SPM for all smoking-related cancers decreased between 2000 and 2003 (annual percentage change [APC] = -13.7%; p = 0.007) but increased slightly between 2003 and 2014 (APC = 1.6%, p = 0.032). We show that 1-in-12 survivors of smoking-related cancers developed an SPM. With the significant increase in the burden of SPM from smoking-related cancers in the last decade, clinicians should be cognizant of long-term smoking-related cancer risks among these patients as part of their survivorship care plans.
尽管癌症幸存者的数量不断增加，但这一人群发生第二原发恶性肿瘤（SPM）的风险增加。我们描述了最常见的与吸烟相关的癌症诊断后幸存者中 SPM 的发生率、最常见的肿瘤部位和负担趋势。本研究是一项基于人群的研究，纳入了 2000 年至 2014 年间监测、流行病学和最终结果（SEER）数据中诊断为前 10 位与吸烟相关的癌症部位的原发性恶性肿瘤患者。使用标准化发病比（SIR）和每 10000 人年风险（PYR）的超额绝对风险（EAR）量化 SPM 风险。使用 Joinpoint 回归模型评估 SPM 负担的趋势。确定了 1608607 例患者队列，其中 119980 例（7.5%）发生了 SPM（76%的 SPM 与吸烟有关）。发生第二原发恶性肿瘤的总 SIR 为 1.51（95%CI，1.50-1.52），与普通人群相比，EAR 为每 10000PYR 73.3 例。头颈部癌症幸存者发生 SPM 的风险最高（SIR = 2.06），膀胱癌的超额负担最高（EAR = 151.4 例/每 10000PYR）。所有与吸烟相关的癌症的 SPM 超额负担在 2000 年至 2003 年期间减少（年百分比变化 [APC] = -13.7%；p = 0.007），但在 2003 年至 2014 年期间略有增加（APC = 1.6%，p = 0.032）。我们表明，每 12 例与吸烟相关的癌症幸存者中就有 1 例发生 SPM。由于过去十年中与吸烟相关的癌症的 SPM 负担显著增加，因此临床医生应在制定这些患者的生存护理计划时，认识到他们长期存在与吸烟相关的癌症风险。
