Zheng Guoqiao, Sundquist Kristina, Sundquist Jan, Chen Tianhui, Försti Asta, Hemminki Otto, Hemminki Kari
Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Eur Urol Open Sci. 2021 Jan 9;24:52-59. doi: 10.1016/j.euros.2020.12.007. eCollection 2021 Feb.
Second primary cancers (SPCs) are increasing due to improving survival in first primary cancers. Previous studies on SPCs in renal cell carcinoma (RCC) have focused on treatment and other risk factors, but data of RCC as an SPC are scarce.
In this study, we want to elucidate the risk for any SPC after RCC, and in reverse order, for RCC as an SPC after any cancer. We additionally consider how family histories influence the risks.
Patient data were obtained from the Swedish Cancer Registry from years 1990 through 2015, and family data were obtained from the Multigeneration Register.
We employed standardized incidence ratios to estimate bidirectional relative risks of subsequent cancer associated with RCC.
We identified 17 587 RCCs (60% in male patients). The highest increases for SPCs were observed for nervous system hemangioblastoma (HB; 26.8), adrenal (12.09) tumors, and renal pelvic cancer (6.32). In the reverse order, RCC as an SPC, nervous system HB (17.01), and adrenal tumors (15.34) were associated with the highest risks. Risks for many other sites (12 sites and subsites) were increased bidirectionally. For women, a total of seven sites and subsites were increased bidirectionally, and many were shared with men. The only significant sex difference in SPCs was the higher lung cancer risk in women (2.41) than in men (1.28). Patients with a family history of HBs or of prostate, colorectal and lung cancers showed high risks of these cancers as SPCs after RCC. Family history accounted for 30% of prostate cancers after RCC.
The bidirectional study design was able to suggest risk factors for SPCs and offered a clinical take-home message urging to consider strategies for early detection and prevention of SPCs. Readily available information on lifestyle (eg, smoking) and family history (eg, prostate cancer) may reveal targets for risk reduction with prognostic benefits.
Close to 10% of kidney cancer patients develop another cancer. The cause for these other cancers may not depend on kidney cancer.
由于原发性癌症患者生存率的提高，第二原发性癌症（SPC）的发病率正在上升。以往关于肾细胞癌（RCC）中SPC的研究主要集中在治疗和其他风险因素上，但关于RCC作为SPC的数据却很稀少。
在本研究中，我们希望阐明RCC后发生任何SPC的风险，反之，任何癌症后发生RCC作为SPC的风险。我们还考虑家族史如何影响这些风险。
设计、设置和参与者：患者数据来自1990年至2015年的瑞典癌症登记处，家族数据来自多代登记处。
我们采用标准化发病率比来估计与RCC相关的后续癌症的双向相对风险。
我们共识别出17587例RCC（60%为男性患者）。SPC发病率增加最高的是神经系统血管母细胞瘤（HB；26.8）、肾上腺（12.09）肿瘤和肾盂癌（6.32）。反之，RCC作为SPC时，神经系统HB（17.01）和肾上腺肿瘤（15.34）的风险最高。许多其他部位（12个部位和亚部位）的风险呈双向增加。对于女性，共有7个部位和亚部位呈双向增加，许多与男性相同。SPC中唯一显著的性别差异是女性患肺癌的风险（2.41）高于男性（1.28）。有HB或前列腺癌、结直肠癌和肺癌家族史的患者，这些癌症作为RCC后的SPC风险较高。家族史占RCC后前列腺癌的30%。
双向研究设计能够提示SPC的风险因素，并提供了一条临床实用信息，敦促人们考虑早期检测和预防SPC的策略。关于生活方式（如吸烟）和家族史（如前列腺癌）的现成信息可能揭示降低风险的目标，具有预后益处。
近10%的肾癌患者会发生另一种癌症。这些其他癌症的病因可能与肾癌无关。
