Wu Meijuan, Huang Mengxi, He Chenglong, Chen Cheng, Li Huiyu, Wang Jing, Liu Mengyan, Fu Gongbo, Lei Zengjie, Chu Xiaoyuan
Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Medical Oncology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.
Front Oncol. 2021 Mar 10;11:650937. doi: 10.3389/fonc.2021.650937. eCollection 2021.
Previous studies have revealed an increased risk of second primary malignancies (SPMs) after colorectal cancer (CRC); however, no previous investigation has quantified differences in the risk of SPMs based on the histological subtypes of first primary CRC. Patients diagnosed with first primary CRC between 2000 and 2011 were identified from the Surveillance, Epidemiology, and End Results cancer registries. The patients were divided into three cohorts: classical adenocarcinoma (CA), mucinous adenocarcinoma (MA), and signet-ring cell carcinoma (SRCC). Standardized incidence ratios were calculated to assess the risk of SPMs among the patients. Overall risk of SPMs was significantly higher among patients with three histological subtypes of CRC than in the general population. The risk of esophagus cancer was significantly increased in SRCC. The risk of small intestine, colon and rectum, and corpus uteri cancers was high in three histological subtypes, with the highest risk observed in SRCC, followed by MA. Increased risks of second stomach, uterus, urinary bladder, kidney, and thyroid cancers were only observed in CA patients, while increased risk of second renal pelvis cancer was limited to MA patients. Furthermore, the high overall risk of SPMs in CA patients persisted regardless of clinicopathological factors. After surgery combined with chemotherapy treatment, CA patients were more prone to developing second small intestine, colon and rectum cancers than those treated with surgery only. A lower second prostate cancer risk was observed in rectal CA patients treated with surgery combined with radiotherapy than in patients treated with surgery only. The present study revealed that the risk of developing SPMs after CRC varied based on the histological subtypes of the first primary CRC. Although the mechanisms underlying the observed patterns of SPM risk remain unknown, the study provided insights into future cancer surveillance based on the histological subtypes of CRC.
既往研究显示，结直肠癌（CRC）患者发生第二原发性恶性肿瘤（SPM）的风险增加；然而，既往尚无研究基于第一原发性CRC的组织学亚型对SPM风险差异进行量化。从监测、流行病学和最终结果癌症登记处识别出2000年至2011年间诊断为第一原发性CRC的患者。这些患者被分为三个队列：经典腺癌（CA）、黏液腺癌（MA）和印戒细胞癌（SRCC）。计算标准化发病率以评估患者中SPM的风险。CRC三种组织学亚型患者的SPM总体风险显著高于一般人群。SRCC患者患食管癌的风险显著增加。小肠、结肠和直肠以及子宫体癌在三种组织学亚型中的风险较高，其中SRCC风险最高，其次是MA。仅在CA患者中观察到第二原发性胃癌、子宫癌、膀胱癌、肾癌和甲状腺癌的风险增加，而第二原发性肾盂癌风险增加仅限于MA患者。此外，无论临床病理因素如何，CA患者SPM的总体高风险持续存在。手术联合化疗后，CA患者比仅接受手术治疗的患者更容易发生第二原发性小肠、结肠和直肠癌。与仅接受手术治疗的患者相比，接受手术联合放疗的直肠CA患者发生第二原发性前列腺癌的风险较低。本研究表明，CRC后发生SPM的风险因第一原发性CRC的组织学亚型而异。尽管观察到的SPM风险模式背后的机制尚不清楚，但该研究为基于CRC组织学亚型的未来癌症监测提供了见解。
