Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan, 430022, China.
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China.
Sci Rep. 2021 Dec 8;11(1):23579. doi: 10.1038/s41598-021-00602-1.
Most cancer patients die of non-cancer causes, and peptic ulcer is one cause that deserves attention. To characterize the incidence and risk factors of death from peptic ulcer among cancer patients, we extracted the data of cancer patients registered in the Surveillance Epidemiology and End Results (SEER) program from 1975 to 2016. Out of the 8,471,051 patients extracted from SEER, 4,698 died from peptic ulcer, with a mortality rate of 9.08/100,000 person-years. Meanwhile, the mortality rate in the general population was 5.09/100,000 person-years, giving a standardized mortality ratio (SMR) of 1.78 (95% confidence interval, 1.73-1.84). Patients who are female, of other race, unmarried, and with distant tumor stage have greater SMRs. A higher SMR was associated with a younger age at diagnosis. Among those aged < 40 years at diagnosis, the plurality of fatal peptic ulcers occurred in patients with leukemia and lymphoma, while in patients aged > 40 years, the majority occurred in those with prostate, breast, colorectum, and lung cancer. Patients with upper digestive system malignancies had the highest SMRs and hazard ratios (HRs), which could be ascribed to radiotherapy-induced damage to the gastroduodenum. The risk declined rapidly one year after diagnosis. However, the SMRs in the upper digestive system cancer survivors increased significantly over ten years after diagnosis. Upper digestive system cancers adjacent to the gastroduodenum were associated with higher SMRs and HRs compared with other types of cancer, possibly contributing partially to the damage caused by radiotherapy on the radiosensitive gastroduodenum.
大多数癌症患者死于非癌症原因，而消化性溃疡是值得关注的原因之一。为了描述癌症患者消化性溃疡死亡的发生率和危险因素，我们从 1975 年至 2016 年从监测、流行病学和最终结果（SEER）计划中提取了癌症患者的数据。从 SEER 中提取的 8471051 名患者中，有 4698 人死于消化性溃疡，死亡率为 9.08/100000 人年。与此同时，一般人群的死亡率为 5.09/100000 人年，标准化死亡率比（SMR）为 1.78（95%置信区间，1.73-1.84）。女性、其他种族、未婚和远处肿瘤分期的患者 SMR 更高。较高的 SMR 与诊断时年龄较小有关。在诊断时年龄<40 岁的患者中，大多数致命性消化性溃疡发生在白血病和淋巴瘤患者中，而在诊断时年龄>40 岁的患者中，大多数发生在前列腺癌、乳腺癌、结直肠癌和肺癌患者中。上消化道系统恶性肿瘤患者的 SMR 和危险比（HR）最高，这可能归因于放疗对胃十二指肠的损伤。诊断后一年风险迅速下降。然而，上消化道系统癌症幸存者在诊断后十年内 SMR 显著增加。与其他类型的癌症相比，紧邻胃十二指肠的上消化道系统癌症与更高的 SMR 和 HR 相关，这可能部分归因于放疗对胃十二指肠的辐射敏感性损伤。
