Chou Wen-Ru, Shia Ben-Chang, Huang Yen-Chun, Ho Chieh-Wen, Chen Mingchih
Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 242062, Taiwan.
Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242062, Taiwan.
J Clin Med. 2022 Sep 4;11(17):5222. doi: 10.3390/jcm11175222.
Lung cancer survivors are at risk of developing second primary cancers (SPCs). Although some risk factors for the development of SPCs have been addressed, their impacts have not been clarified. This study, based on Taiwan’s National Health Insurance Research Database (NHIRD), a nationwide database, was designed to investigate the risk factors for SPCs in patients with initial lung cancer and identify the impacts of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment on the development of SPCs. In this study, 37,954 individuals were included, of whom 2819 had SPCs. These patients were further divided into the second primary lung cancers (SPLC) and second primary extrapulmonary cancer (SPEC) groups. Among the patients with lung cancer without SPCs, those aged <65 years accounted for 53.15%. Patients aged ≥65 years accounted for 40.18% and 53.24% in the SPLC and SPEC groups, respectively. Females accounted for 50.3% of patients without SPC, 54% of the SPLC group, and 44.3% of the SPEC group. Univariate and multivariate Cox proportional hazard models showed increased hazard ratios for smoking, hypertension, and diabetes mellitus, and lower HRs for surgery, chemotherapy, radiotherapy, and TKIs. Patients undergoing surgery, chemotherapy, and radiotherapy were associated with a lower risk of SPCs. Treatment with EGFR TKIs was a significant and independent factor associated with lower incidence of SPCs. This study may encourage researchers to establish predictive models based on our results to assess the risk factors for SPCs, and therefore, early screening and intervention could be applied, and the SPCs-related mortality and relevant medical costs could be reduced.
肺癌幸存者有患第二原发性癌症（SPC）的风险。尽管已经探讨了一些SPC发生的风险因素，但其影响尚未明确。本研究基于台湾全民健康保险研究数据库（NHIRD）这一全国性数据库，旨在调查初发肺癌患者发生SPC的风险因素，并确定表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）治疗对SPC发生的影响。本研究纳入了37954名个体，其中2819人患有SPC。这些患者进一步分为第二原发性肺癌（SPLC）组和第二原发性肺外癌症（SPEC）组。在无SPC的肺癌患者中，年龄<65岁者占53.15%。在SPLC组和SPEC组中，年龄≥65岁者分别占40.18%和53.24%。女性在无SPC患者中占50.3%，在SPLC组中占54%，在SPEC组中占44.3%。单因素和多因素Cox比例风险模型显示，吸烟、高血压和糖尿病的风险比增加，而手术、化疗、放疗和TKI的风险比降低。接受手术、化疗和放疗的患者发生SPC的风险较低。EGFR TKI治疗是与SPC发生率较低相关的一个显著且独立的因素。本研究可能会鼓励研究人员根据我们的结果建立预测模型，以评估SPC的风险因素，从而能够进行早期筛查和干预，降低与SPC相关的死亡率和相关医疗费用。
