Massachusetts General Hospital Biostatistics Center & Department of Biostatistics, Harvard T.H. Chan School of Public Health, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA.
Massachusetts General Hospital Biostatistics Center, Boston, MA, USA.
BMC Cancer. 2019 Feb 21;19(1):166. doi: 10.1186/s12885-019-5358-1.
Although rare cancers account for 27% of cancer diagnoses in the US, there is insufficient research on survivorship issues in these patients. An important issue cancer survivors face is an elevated risk of being diagnosed with new primary cancers. The primary aim of this analysis was to assess whether a history of rare cancer increases the risk of subsequent cancer compared to survivors of common cancers.
This was a prospective cohort study of 16,630 adults with personal and/or family history of cancer who were recruited from cancer clinics at 14 geographically dispersed US academic centers of the NIH-sponsored Cancer Genetics Network (CGN). Participants' self-reported cancer histories were collected at registration to the CGN and updated annually during follow-up. At enrollment, 14% of participants reported a prior rare cancer. Elevated risk was assessed via the cause-specific hazard ratio on the time to a subsequent cancer diagnosis.
After a median follow-up of 7.9 years, relative to the participants who were unaffected at enrollment, those with a prior rare cancer had a 23% higher risk of subsequent cancer (95% CI: -1 to 52%), while those with a prior common cancer had no excess risk. Patients having two or more prior cancers were at a 53% elevated risk over those with fewer than two (95% CI: 21 to 94%) and if the multiple prior cancers were rare cancers, risk was further elevated by 47% (95% CI: 1 to 114%).
There is evidence suggesting that survivors of rare cancers, especially those with multiple cancer diagnoses, are at an increased risk of a subsequent cancer. There is a need to study this population more closely to better understand cancer pathogenesis.
虽然罕见癌症占美国癌症诊断的 27%，但针对这些患者的生存问题研究还不够充分。癌症幸存者面临的一个重要问题是新原发性癌症的风险增加。本分析的主要目的是评估与常见癌症幸存者相比，既往罕见癌症史是否会增加随后发生癌症的风险。
这是一项前瞻性队列研究，纳入了来自美国国立卫生研究院（NIH）赞助的癌症遗传学网络（CGN）的 14 个地理位置分散的学术癌症诊所的 16630 名有个人和/或家族癌症史的成年人。参与者在 CGN 注册时报告了他们的癌症病史，并在随访期间每年更新。在登记时，14%的参与者报告了既往罕见癌症史。通过随后癌症诊断的特定原因风险比来评估风险升高。
中位随访 7.9 年后，与登记时未受影响的参与者相比，既往有罕见癌症史的参与者随后发生癌症的风险增加了 23%（95% CI：-1 至 52%），而既往有常见癌症史的参与者无额外风险。既往有两次或更多次癌症的患者的风险比既往有少于两次癌症的患者高 53%（95% CI：21 至 94%），如果多次既往癌症为罕见癌症，则风险进一步增加 47%（95% CI：1 至 114%）。
有证据表明，罕见癌症幸存者，尤其是多次癌症诊断的幸存者，发生后续癌症的风险增加。需要更密切地研究这一人群，以更好地了解癌症发病机制。
