Capezzone Marco, Sagnella Alfonso, Cantara Silvia, Fralassi Noemi, Maino Fabio, Forleo Raffaella, Brilli Lucia, Pilli Tania, Cartocci Alessandra, Castagna Maria Grazia
Unit of Endocrinology, Misericordia Hospital, Grosseto, Italy.
Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
Front Endocrinol (Lausanne). 2022 Mar 4;13:845954. doi: 10.3389/fendo.2022.845954. eCollection 2022.
Survival rates in patients with non-medullary thyroid carcinoma (NMTC) are high, increasing the possibility to develop a second malignant neoplasm (SMN). Many studies investigated the relationship between increased risk of SMN in NMTC patients treated with radioiodine, but few data are available about the impact of family history (FH) of thyroid cancer on SMN risk.
To assess the risk of SMN in a large cohort of sporadic and familial NMTC using the standardized incidence ratio (SIR).
We studied 918 NMTC patients (73.9% female patients) followed for a median follow-up of 9 years. In 798/918 (86.9%) patients, NMTC was sporadic, while the remaining 120 (13.1%) were familial NMTC (FNMTC).
We identified 119/918 (13%) patients with SMN in association with NMTC. NMTCs had an increased risk of SMN when compared to the general population (SIR 2.1, 95% CI 1.7-2.5). The rate of SMN for all sites was significantly higher in familial compared to sporadic NMTC (20% versus 11.9%, = 0.01), primarily driven by families with more than two affected members. The risk of SMN was remarkably higher for breast cancer, especially in familial cases (SIR 22.03, 95% CI 14.4-41.2) compared to sporadic cases (SIR:17, 95% CI 11.9-24.6).
NMTC patients have a higher risk of SMN compared to the general population and this risk is much higher in patients with FNMTC. This observation raises the hypothesis that genetic risk factors for a first cancer may predispose to SMN, especially among individuals with familial clustering of the same or other tumors.
非髓样甲状腺癌（NMTC）患者的生存率较高，这增加了发生第二原发性恶性肿瘤（SMN）的可能性。许多研究调查了接受放射性碘治疗的NMTC患者发生SMN风险增加之间的关系，但关于甲状腺癌家族史（FH）对SMN风险的影响的数据很少。
使用标准化发病比（SIR）评估一大群散发性和家族性NMTC患者中SMN的风险。
我们研究了918例NMTC患者（73.9%为女性患者），中位随访时间为9年。在918例患者中的798例（86.9%）中，NMTC为散发性，其余120例（13.1%）为家族性NMTC（FNMTC）。
我们确定918例患者中有119例（13%）发生了与NMTC相关的SMN。与一般人群相比，NMTC发生SMN的风险增加（SIR 2.1，95%CI 1.7 - 2.5）。家族性NMTC中所有部位的SMN发生率显著高于散发性NMTC（20%对11.9%，P = 0.01），主要由两个以上受影响成员的家族驱动。乳腺癌发生SMN的风险显著更高，尤其是家族性病例（SIR 22.03，95%CI 14.4 - 41.2），而散发性病例（SIR：17，95%CI 11.9 - 24.6）。
与一般人群相比，NMTC患者发生SMN的风险更高，而FNMTC患者的这种风险更高。这一观察结果提出了一个假设，即首例癌症的遗传风险因素可能使个体易患SMN，尤其是在同一或其他肿瘤家族聚集的个体中。
