Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
University of Alabama at Birmingham, Department of Surgery, Division of Surgical Oncology, Birmingham, Alabama, USA.
Endocr Relat Cancer. 2023 Jun 26;30(8). doi: 10.1530/ERC-22-0337. Print 2023 Aug 1.
There is an increased risk of second primary cancers (SPCs) after neuroendocrine tumor (NET) diagnosis. The clinical significance of SPCs in this population is unknown. The purpose of this study was to evaluate the association between SPCs after NET diagnosis and survival. We performed a population-based, retrospective cohort study of NET patients (gastrointestinal, pancreatic, or lung primary) from 2000 to 2016 using the Surveillance, Epidemiology, and End Results database. Cox regression models assessed the association between SPCs and NET-specific (NET-SS), cancer-specific (CSS), and overall survival (OS). Of 58,553 NET patients, 7.9% experienced an SPC. SPCs were associated with worse OS (hazard ratio (HR) 2.14, 95% CI 1.94-2.36) and CSS (HR 2.31, 95% CI 2.06-2.59) with no difference in NET-SS (HR 1.04, 95% CI 0.87-1.23). Stratified analyses by histologic grade showed similar results for well and moderately differentiated NETs, but no difference in OS or CSS for poorly differentiated NETs (P > 0.05). In stratified analyses by NET site, SPCs were associated with worse OS (HR 3.41, 95% CI 3.01-3.87) and CSS (HR 4.96, 95% CI 4.28-5.74) in gastrointestinal NETs and worse OS (HR 1.25, 95% CI 1.03-1.52) with no difference in CSS (HR 1.08, 95% CI 0.85-1.36) in lung NETs. SPCs were not associated with a difference in OS or CSS in pancreatic NETs (P > 0.05). In conclusion, SPCs after NETs were associated with inferior OS and CSS compared to no SPC but were not associated with NET-SS. These data highlight the need for long-term follow-up in NETs to include the detection of SPCs to ensure early diagnosis and timely management.
神经内分泌肿瘤（NET）诊断后发生第二原发癌（SPC）的风险增加。该人群中 SPC 的临床意义尚不清楚。本研究的目的是评估 NET 诊断后 SPC 与生存之间的关系。我们使用监测、流行病学和最终结果（SEER）数据库，对 2000 年至 2016 年间的胃肠胰或肺原发性 NET 患者进行了基于人群的回顾性队列研究。Cox 回归模型评估了 SPC 与 NET 特异性（NET-SS）、癌症特异性（CSS）和总生存（OS）之间的关系。在 58553 例 NET 患者中，7.9%发生 SPC。SPC 与较差的 OS（风险比（HR）2.14，95%置信区间（CI）1.94-2.36）和 CSS（HR 2.31，95%CI 2.06-2.59）相关，但 NET-SS 无差异（HR 1.04，95%CI 0.87-1.23）。按组织学分级的分层分析显示，分化良好和中度分化的 NET 结果相似，但分化不良的 NET 在 OS 或 CSS 方面无差异（P>0.05）。按 NET 部位分层分析显示，SPC 与胃肠 NET 的较差 OS（HR 3.41，95%CI 3.01-3.87）和 CSS（HR 4.96，95%CI 4.28-5.74）相关，与肺 NET 的较差 OS（HR 1.25，95%CI 1.03-1.52）相关，但 CSS 无差异（HR 1.08，95%CI 0.85-1.36）。SPC 与胰腺 NET 的 OS 或 CSS 无差异（P>0.05）。总之，与无 SPC 相比，NET 后发生的 SPC 与较差的 OS 和 CSS 相关，但与 NET-SS 无关。这些数据强调了在 NET 中进行长期随访的必要性，包括检测 SPC，以确保早期诊断和及时治疗。
