Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Gastroenterol Hepatol. 2023 Jun;38(6):930-939. doi: 10.1111/jgh.16156. Epub 2023 Mar 6.
Radiation therapy (RT) is a crucial modality for the local control of esophageal cancer (EC), but the effect of RT on the development of secondary thoracic malignancies is still unclear. This study aims to identify the association between RT for the treatment of primary EC and subsequent secondary thoracic cancer (STC).
The primary EC patients were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing risk regression and standardized incidence ratio (SIR) were used to evaluate the radiotherapy-associated cancer risk. Overall survival (OS) was compared by Kaplan-Meier analysis.
A total of 40 255 EC patients from the SEER database were identified, of which 17 055 patients (42.37%) did not receive radiotherapy (NRT) and 23 200 patients (57.63%) had been treated with RT. After 12 months of latency, 162 patients (0.95%) in the NRT group and 272 patients (1.17%) in the RT group developed STC. The incidences of the RT group were significantly higher than the NRT group. Patients who have primary EC were at an increased risk of developing STC (SIR = 1.79, 95% CI: 1.63-1.96). The SIR of STC was 1.37 (95% CI: 1.16-1.60) in the NRT group and 2.10 (95% CI: 1.87-2.34) in the RT group. The OS of STC patients in the RT group was significantly lower than the NRT group (P = 0.006).
The RT for primary EC was associated with higher risks of developing STC than patients unexposed to radiotherapy. The EC patients treated with RT, especially young patients, require long-term monitoring of the risk of STC.
放射治疗（RT）是控制食管癌（EC）局部的关键手段，但 RT 对继发性胸内恶性肿瘤发展的影响尚不清楚。本研究旨在确定原发性 EC 患者接受 RT 治疗与随后发生的继发性胸内癌（STC）之间的关系。
从监测、流行病学和最终结果（SEER）数据库中检索原发性 EC 患者。使用 Fine-Gray 竞争风险回归和标准化发病比（SIR）评估放疗相关癌症风险。通过 Kaplan-Meier 分析比较总生存（OS）。
从 SEER 数据库中确定了 40255 例 EC 患者，其中 17055 例（42.37%）未接受放疗（NRT），23200 例（57.63%）接受了 RT。潜伏期 12 个月后，NRT 组有 162 例（0.95%）和 RT 组有 272 例（1.17%）患者发生 STC。RT 组的发病率明显高于 NRT 组。患有原发性 EC 的患者发生 STC 的风险增加（SIR=1.79，95%CI：1.63-1.96）。NRT 组 STC 的 SIR 为 1.37（95%CI：1.16-1.60），RT 组为 2.10（95%CI：1.87-2.34）。RT 组 STC 患者的 OS 明显低于 NRT 组（P=0.006）。
与未接受放疗的患者相比，原发性 EC 的 RT 治疗与发生 STC 的风险更高。接受 RT 治疗的 EC 患者，尤其是年轻患者，需要长期监测 STC 的风险。
