Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, P. O. Box 19664, Springfield, IL 62794-9664, USA; Simmons Cancer Institute, Southern Illinois University School of Medicine, 315 W Carpenter St, Springfield, IL 62702, USA.
Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL 62702, USA.
Gynecol Oncol. 2020 Sep;158(3):719-726. doi: 10.1016/j.ygyno.2020.06.492. Epub 2020 Jun 30.
Survivors of gynecologic cancers have an increased risk of developing second primary cancers (SPC); however it is unclear which sites have higher risks. We aimed to ascertain risk of SPC among survivors of gynecological cancer, and identify anatomic sites at risk of SPC.
We queried the Surveillance, Epidemiology and End Results database (2000-2016) for confirmed cases of index gynecological (cervix uteri [cervical], corpus and uterus [endometrial], ovarian, vaginal, and vulvar) cancers. Risk of SPC was estimated using standardized incidence ratios (SIRs: observed/expected cases) and excess absolute risks (EARs: observed - expected cases) per 10,000 person-years at risk (PYR). SIRs and EARs were stratified by index anatomic site and latency interval.
Among the cohort of 301,210 gynecological cancer survivors, 19,005 (6.31%) developed an SPC (SIR = 1.16; 95% CI, 1.15-1.18 and EAR = 17.2 cases per 10,000 PYR) compared with the general population. All gynecological cancer survivors (except survivors of ovarian) had a significant risk of developing SPC (SIR range 1.06-2.16), with survivors of vulvar cancer having the highest risk (SIR = 2.16; 95% CI, 2.06-2.27; EAR = 139.5 per 10,000 PYR). Risk of SPC was highest within the first 5 years post-diagnosis for survivors of cervical, vulvar and vaginal cancers.
While most index gynecological cancer sites are associated with increased risk of SPC, risk is highest among survivors of vulvar cancer. These findings have the potential to inform lifelong surveillance recommendations for gynecological cancer survivors.
妇科癌症幸存者发生第二原发癌（SPC）的风险增加；然而，哪些部位的风险更高尚不清楚。我们旨在确定妇科癌症幸存者 SPC 的风险，并确定 SPC 的风险部位。
我们在监测、流行病学和最终结果数据库（2000-2016 年）中查询了确诊的索引妇科（子宫颈[宫颈]、子宫体和子宫[子宫内膜]、卵巢、阴道和外阴）癌症病例。使用标准化发病比（SIR：观察/预期病例）和每 10000 人风险年（PYR）的超额绝对风险（EAR：观察-预期病例）来估计 SPC 的风险。SIR 和 EAR 按索引解剖部位和潜伏期分层。
在 301210 名妇科癌症幸存者队列中，有 19005 名（6.31%）发生 SPC（SIR=1.16；95%CI，1.15-1.18 和 EAR=17.2 例/10000PYR）与普通人群相比。除卵巢癌幸存者外，所有妇科癌症幸存者（SIR 范围为 1.06-2.16）均有发生 SPC 的显著风险，外阴癌幸存者的风险最高（SIR=2.16；95%CI，2.06-2.27；EAR=139.5/10000PYR）。宫颈癌、外阴癌和阴道癌幸存者在诊断后 5 年内 SPC 风险最高。
虽然大多数索引妇科癌症部位与 SPC 风险增加相关，但外阴癌幸存者的风险最高。这些发现有可能为妇科癌症幸存者提供终身监测建议。
