Mega Data Application Center of Department of Information Management, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, People's Republic of China.
Department of Pharmacy, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, People's Republic of China.
Int J Colorectal Dis. 2022 Aug;37(8):1785-1797. doi: 10.1007/s00384-022-04202-x. Epub 2022 Jul 7.
The rate of second primary malignancies (SPM) is gradually increasing. Yet, the risk of death from primary cancer vs. SPM is still not well understood. In this study, we investigated the survival of patients with colorectal cancer (as SPM) who had cancer in the past (prior cancer) and the risk factors of SPM death in this population.
Based on the Surveillance, Epidemiology, and End Results (SEER) database, we identified 1866 colon cancer patients with prior cancer in our main cohort and 43,959 colon cancer patients, including 37,440 patients with colon cancer as only malignancy and 6519 patients with colon cancer as subsequent colon cancer (SCC), in a second cohort and 3429 colon cancer patients, including 2371 patients with prior colon cancer (PCC) and 1058 patients with colon cancer as SPM, in a third cohort. After propensity score matching, 6519 pairs of subjects were identified in second cohort.
Patients with prior prostate and breast cancer had a higher risk of developing colon cancer compared to those with gastrointestinal cancer. Also, colon cancer patients with different prior cancer had different survival rates. Furthermore, except for prior lung cancer (52.78 vs. 25.93%), most subjects died due to colon cancer complications. The ratio of colon cancer deaths to prior cancer deaths in patients with a low stage and high stage was 1.51 and 6.64, respectively. In addition, colon cancer-specific survival (CSS) and OS rates were significantly lower in subjects with colon cancer as the SPM than in those with PCC. Also, compared with PCC, SPM was associated with OS and CSS with HR 1.59 (95 CI 1.43-1.78) and HR 2.00 (95% CI 1.70-2.36). Furthermore, compared with only colon cancer, SCC was associated with OS and CSS with HR 1.23 (95 CI 1.17-1.29) and HR 1.13 (95% CI 1.06-1.21).
Prior cancer was found to have an adverse impact on OS in patients with colon cancer (secondary cancer), most of whom died due to colon cancer as secondary cancer itself rather than prior cancer. Early detection and treatment strategies should be investigated in this population.
第二原发恶性肿瘤（SPM）的发病率逐渐增高。然而，原发癌与 SPM 相关的死亡风险仍不清楚。本研究旨在探讨既往患有恶性肿瘤（先前癌症）的结直肠癌（SPM）患者的生存情况，并分析该人群中 SPM 死亡的相关危险因素。
基于监测、流行病学和最终结果（SEER）数据库，我们在主要队列中纳入了 1866 例先前患有癌症的结肠癌患者，并在第二个队列中纳入了 43959 例结肠癌患者，包括 37440 例仅有结肠癌的患者和 6519 例随后发生结肠癌（SCC）的患者；在第三个队列中纳入了 3429 例结肠癌患者，包括 2371 例先前患有结肠癌（PCC）的患者和 1058 例结肠癌作为 SPM 的患者。在第二个队列中，经倾向评分匹配后，共纳入了 6519 对患者。
与胃肠道恶性肿瘤相比，先前患有前列腺癌和乳腺癌的患者发生结肠癌的风险更高。此外，具有不同先前癌症的结肠癌患者的生存率也不同。此外，除了先前患有肺癌（52.78%比 25.93%）的患者外，大多数患者死于结肠癌并发症。低分期和高分期患者中结肠癌死亡与先前癌症死亡的比例分别为 1.51 和 6.64。此外，与 PCC 相比，SPM 患者的结肠癌特异性生存率（CSS）和总生存率（OS）明显较低。与 PCC 相比，SPM 与 OS 和 CSS 的风险比（HR）分别为 1.59（95%CI 1.43-1.78）和 2.00（95%CI 1.70-2.36）。此外，与仅结肠癌相比，SCC 与 OS 和 CSS 的 HR 分别为 1.23（95%CI 1.17-1.29）和 1.13（95%CI 1.06-1.21）。
先前癌症会对结肠癌（继发性癌症）患者的 OS 产生不良影响，其中大多数患者死于继发性癌症本身，而非先前癌症。应在该人群中研究早期发现和治疗策略。
