Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China.
Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Bosn J Basic Med Sci. 2022 Jun 1;22(3):471-480. doi: 10.17305/bjbms.2021.6338.
The aim of this study was to investigate the impacts of radiation therapy (RT) on the occurrence risk of secondary bladder cancer (SBC) and on the patients' survival outcome after being diagnosed with gynecological cancer (EC). The data was obtained from the SEER database between 1973 and 2015. Chi-squared test was used to compare the clinicopathological characteristics among the different groups. Fine and Gray's competing risk model was used to assess the cumulative incidence and occurrence risk of SBC in GC survivors. Kaplan-Meier method was utilized for survival analysis. A total of 123,476 GC patients were included, among which 31,847 (25.8%) patients received RT while 91629 (74.2%) patients did not. The cumulative incidence of SBC was 1.59% or 0.73% among patients who had received prior GC specific RT or not, respectively. All EBRT (standardized incidence ratio (SIR) =2.49, 95% CI [2.17-2.86]), brachytherapy (SIR =1.96, 95% CI [1.60-2.38]), and combinational RT modality groups (SIR =2.73, 95% CI [2.24-3.28]) had dramatically higher SBC incidence as compared to the US general population. Receiving EBRT (HR = 2.83, 95% CI [2.34-3.43]), brachytherapy (HR = 2.17, 95% CI [1.67-2.82]), and combinational RT modality (HR = 2.97, 95% CI [2.34-3.77]) were independent risk factors for SBC development. Survival detriment was observed in SBC patients who received RT after GC diagnosis, as compared to those who did not receive RT. In conclusion, patients who underwent RT after GC had an increased risk of developing bladder as a secondary primary cancer. A long-term surveillance for SBC occurrence is necessary for GC patients who have received prior RT.
本研究旨在探讨放射治疗（RT）对妇科癌症（EC）患者发生继发性膀胱癌（SBC）的风险及生存结局的影响。数据来自 1973 年至 2015 年的 SEER 数据库。采用卡方检验比较不同组间的临床病理特征。采用 Fine-Gray 竞争风险模型评估 GC 幸存者中 SBC 的累积发生率和发生风险。采用 Kaplan-Meier 法进行生存分析。共纳入 123476 例 GC 患者，其中 31847 例（25.8%）患者接受 RT，91629 例（74.2%）患者未接受 RT。接受过 GC 特异性 RT 治疗的患者 SBC 的累积发生率为 1.59%，未接受过的患者为 0.73%。所有 EBRT（标准化发病比（SIR）=2.49，95%CI[2.17-2.86]）、近距离放疗（SIR=1.96，95%CI[1.60-2.38]）和联合 RT 模式组（SIR=2.73，95%CI[2.24-3.28]）SBC 发病率明显高于美国一般人群。接受 EBRT（HR=2.83，95%CI[2.34-3.43]）、近距离放疗（HR=2.17，95%CI[1.67-2.82]）和联合 RT 模式（HR=2.97，95%CI[2.34-3.77]）是 SBC 发生的独立危险因素。与未接受 RT 的患者相比，GC 诊断后接受 RT 的 SBC 患者的生存状况恶化。总之，GC 患者接受 RT 后发生膀胱癌的风险增加。对于接受过 RT 的 GC 患者，需要长期监测 SBC 的发生。
