Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
J Transl Med. 2022 Sep 5;20(1):405. doi: 10.1186/s12967-022-03544-y.
Second primary malignancy (SPM) represents the leading long-term cause of death among patients with index head and neck squamous cell carcinoma (HNSCC). We aimed to quantify the association between postoperative radiotherapy (PORT) and the risk of SPM development for index HNSCC among adolescent and young patients, who are particularly vulnerable to radiation-associated impacts due to their increased tissue susceptibilities and longer life expectancies.
This study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of 5 year survivors of index young-onset HNSCC from 1975 to 2011. The outcome of interest was SPM, a new, metachronous malignancy after the index HNSCC. Standardized incidence ratios (SIRs) and excess absolute risks (EARs) were used to quantify the PORT-associated risks externally, and relative risks (RRs) were estimated by the multivariate Poisson regression analysis to quantify the PORT-associated risks internally.
Of the included 2771 5 year survivors with index young-onset HNSCCs, the receipt of PORT (37.6%) was associated with higher risk of SPMs (RR, 1.23; 95% CI 1.07 to 1.43). PORT-associated risks were elevated for the majority of sites, including head and neck (RR, 1.19; 95% CI 0.95 to 1.50) and lung (RR, 1.67; 95% CI 1.18 to 2.34). With regarding to the subsites of head and neck, RRs were above unity in oral cavity squamous cell carcinoma (SCC) (RR, 1.68; 95% CI 1.39 to 2.03) and laryngeal SCC (RR, 1.02; 95% CI 0.73 to 1.43). A relatively greater RR was observed for patients younger than 35 years (RR, 1.44, 95% CI 0.37 to 5.57) and those diagnosed with localized diseases (RR, 1.16, 95% CI 0.9 to 1.5). PORT-associated risks were increased remarkably after 15 years of follow-up (RR, 1.24; 95% CI 0.97 to 1.58).
An association was discovered between PORT treatment and increased long-term risk of SPM among patients with index young-onset HNSCC. The findings suggest long-term follow-up surveillance for these patients, particularly those with oral cavity SCC or laryngeal SCC.
第二原发恶性肿瘤（SPM）是索引头颈部鳞状细胞癌（HNSCC）患者长期死亡的主要原因。我们旨在量化青少年和年轻患者接受术后放疗（PORT）与索引 HNSCC 中 SPM 发展风险之间的关联，这些患者由于组织敏感性增加和预期寿命延长，特别容易受到辐射相关影响。
本研究使用监测、流行病学和最终结果（SEER）数据库收集了 1975 年至 2011 年间索引年轻发病 HNSCC 5 年幸存者的数据。感兴趣的结果是 SPM，即在索引 HNSCC 后发生的新的、异时性恶性肿瘤。标准化发病率比（SIR）和超额绝对风险（EAR）用于外部量化 PORT 相关风险，相对风险（RR）通过多变量泊松回归分析进行估计，以量化内部 PORT 相关风险。
在纳入的 2771 名索引年轻发病 HNSCC 5 年幸存者中，接受 PORT（37.6%）与 SPM 风险增加相关（RR，1.23；95%CI 1.07 至 1.43）。PORT 相关风险在大多数部位升高，包括头颈部（RR，1.19；95%CI 0.95 至 1.50）和肺部（RR，1.67；95%CI 1.18 至 2.34）。就头颈部的亚部位而言，口腔鳞状细胞癌（SCC）（RR，1.68；95%CI 1.39 至 2.03）和喉 SCC（RR，1.02；95%CI 0.73 至 1.43）的 RR 高于 1。年龄小于 35 岁（RR，1.44，95%CI 0.37 至 5.57）和诊断为局限性疾病（RR，1.16，95%CI 0.9 至 1.5）的患者 RR 相对较高。随访 15 年后，PORT 相关风险显著增加（RR，1.24；95%CI 0.97 至 1.58）。
在索引年轻发病 HNSCC 患者中，PORT 治疗与 SPM 长期风险增加之间存在关联。这些发现表明需要对这些患者进行长期随访监测，特别是口腔 SCC 或喉 SCC 患者。
