Zhuang Liping, Yan Xia, Meng Zhiqiang
Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China,
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
Cancer Manag Res. 2019 Mar 1;11:1969-1983. doi: 10.2147/CMAR.S187614. eCollection 2019.
A population-based estimate of risk of second primary malignancy (SPM) in patients with cholangiocarcinoma (CCA) is still lacking.
To investigate the overall and site-specific risk of SPM in patients with CCA. To identify risk factors of SPM and further evaluate the impact of SPM on overall survival (OS) and disease specific survival (DSS) in patients with CCA.
Patients with histologically diagnosed CCA between 1973 and 2015 were identified from the Surveillance, Epidemiology and End Results database. Standardized incidence ratio (SIR) was calculated. Risk factors for SPM and CCA survival were evaluated by logistic, Cox, and nomogram methods.
We found that the overall risk of SPM in patients with CCA was significantly higher than that in the general population (SIR =1.27, 95% CI =1.03-1.55, <0.05). The risk of SPM was significantly increased at specific sites, including transverse colon, intrahepatic bile duct, other biliary, and thyroid. A significant increase in overall risk was characterized in the subgroups of patients aged ≤29, patients aged 30-59 years, females, whites, and patients with latency ≤11 months (63.41, 2.45, 1.4, 1.3, and 2.6-fold, respectively). In patients with CCA, not having undergone surgery for the first primary malignancy (vs having undergone surgery for the first primary malignancy; HR =0.269; 95% CI =0.211-0.342; <0.001) was associated with significantly decreased risk of SPM. Patients with SPM had better OS and DSS than those without SPM (Log rank <0.001). Absence of SPM was an independent risk factor for poorer OS and DSS.
Although the risk of SPM in patients with CCA was significantly increased, the presence of SPM did not shorten OS and DSS of patients with CCA, possibly due to the relatively poorer survival of patients with CCA.
目前仍缺乏基于人群的胆管癌（CCA）患者发生第二原发性恶性肿瘤（SPM）风险的评估。
研究CCA患者发生SPM的总体风险及特定部位风险。识别SPM的风险因素，并进一步评估SPM对CCA患者总生存期（OS）和疾病特异性生存期（DSS）的影响。
从监测、流行病学和最终结果数据库中识别出1973年至2015年间经组织学诊断为CCA的患者。计算标准化发病比（SIR）。通过逻辑回归、Cox回归和列线图方法评估SPM和CCA生存的风险因素。
我们发现，CCA患者发生SPM的总体风险显著高于一般人群（SIR = 1.27，95%可信区间 = 1.03 - 1.55，P < 0.05）。特定部位发生SPM的风险显著增加，包括横结肠、肝内胆管、其他胆管和甲状腺。在年龄≤29岁、30 - 59岁、女性、白人以及潜伏期≤11个月的患者亚组中，总体风险显著增加（分别为63.41倍、2.45倍、1.4倍、1.3倍和2.6倍）。在CCA患者中，未接受首次原发性恶性肿瘤手术（与接受首次原发性恶性肿瘤手术相比；HR = 0.269；95%可信区间 = 0.211 - 0.342；P < 0.001）与SPM风险显著降低相关。发生SPM的患者比未发生SPM的患者具有更好的OS和DSS（对数秩检验P < 0.001）。未发生SPM是OS和DSS较差的独立风险因素。
尽管CCA患者发生SPM的风险显著增加，但SPM的存在并未缩短CCA患者的OS和DSS，这可能是由于CCA患者的生存相对较差。
