喉鳞状细胞癌患者即使在 20 年后仍有发生第二原发癌的显著风险。

Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Acta Oncol. 2023 Oct;62(10):1322-1330. doi: 10.1080/0284186X.2023.2254482. Epub 2023 Sep 6.

BACKGROUND

Evidence on the risk of second primary cancer (SPC) following primary laryngeal squamous cell carcinoma (LSCC) is limited, especially in Europe.

METHODS

Patients diagnosed with primary LSCC from 1953-2018 were retrieved from the Finnish Cancer Registry. A total of 6241 LSCC patients were identified adding to 49,393 person-years (PY) of follow-up until the end of 2019. Only one patient emigrated and was lost to follow-up. Both standardized incidence ratios (SIR) and excess absolute risk (EAR) per 1000 person-years at risk (PYR) of second primary cancer (SPC) were calculated relative to the general population. Only non-laryngeal SPCs diagnosed six months after diagnosis of primary LSCC were included.

RESULTS

A SPC was diagnosed in 1244 LSCC patients (20% of all LSCC patients) over the 65-year period, predominantly in men (92%, = 1170). Out of all SPCs, 34% were diagnosed within 0.5 to 5 years and 66% after 5 years from primary LSCC. Among male patients, the overall SIR for SPC at any location was 1.61 (95% CI: 1.52-1.71), corresponding to 9.49 excess SPCs per 1000 PYR (95% CI: 8.19-11). The corresponding SIR for women was 1.47 (95% CI: 1.15-1.84), yielding 4.82 excess SPCs per 1000 PYR (95% CI: 2.36-9.84). The risk remained significant even after 20 years of follow-up (SIR for all 1.73, 95% CI: 1.49-2.01 and EAR 16.8 per 1000 PY, 11.88-23.75). The risk for SPC was also significantly elevated in all age groups, except <40. The highest SIRs were for SPCs arising in the mouth/pharynx (SIR for all 3.08, 95% CI: 2.36-3.95 and EAR 0.80 per 1000 PY, 0.55-1.15) and lungs (3.02, 2.75-3.30 and 5.90 per 1000, 5.13-6.78).

CONCLUSION

Patients with LSCC as primary cancer have a 60% excess risk for an SPC, especially for tobacco-associated cancers, remaining significantly elevated even decades after treatment.

背景

关于原发性喉鳞状细胞癌（LSCC）后第二原发癌（SPC）风险的证据有限，尤其是在欧洲。

方法

从芬兰癌症登记处检索了 1953 年至 2018 年间诊断为原发性 LSCC 的患者。共确定了 6241 例 LSCC 患者，随访至 2019 年底，随访时间为 49393 人年。只有一名患者移民并失去随访。以每 1000 人年为单位计算第二原发癌（SPC）的标准化发病比（SIR）和超额绝对风险（EAR）。仅包括在诊断为原发性 LSCC 后 6 个月内诊断出的非喉 SPC。

结果

在 65 年的时间里，1244 例 LSCC 患者（所有 LSCC 患者的 20%）被诊断出患有 SPC，主要是男性（92%，即 1170 例）。所有 SPC 中，34%在 0.5 至 5 年内诊断出，66%在原发性 LSCC 后 5 年以上诊断出。在男性患者中，任何部位 SPC 的总体 SIR 为 1.61（95%CI：1.52-1.71），相当于每 1000 人年有 9.49 例 SPC 超额（95%CI：8.19-11）。女性的相应 SIR 为 1.47（95%CI：1.15-1.84），每 1000 人年有 4.82 例 SPC 超额（95%CI：2.36-9.84）。即使在随访 20 年后，风险仍然显著（所有 SIR 为 1.73，95%CI：1.49-2.01，EAR 为 16.8 例/1000 人年，9.84-23.75）。在所有年龄组中，除<40 岁外，SPC 的风险也显著升高。最高的 SIR 是口腔/咽部（SIR 为所有 3.08，95%CI：2.36-3.95，EAR 为每 1000 人 0.80，95%CI：0.55-1.15）和肺部（3.02，2.75-3.30 和 5.90 例/1000 人，95%CI：5.13-6.78）。