Department of Oncology, Wujin Hospital Affiliated with Jiangsu University, Yong Ning North Road No. 2, Changzhou, 213000, Jiangsu, China.
Department of Oncology, The Wujin Clinical College of Xuzhou Medical University, Yong Ning North Road No. 2, Changzhou, 213000, Jiangsu, China.
Sci Rep. 2024 Mar 8;14(1):5766. doi: 10.1038/s41598-024-56408-4.
Due to the long-term low survival rates of gastric adenocarcinoma (GAC) patients, the occurrence and prognosis of second primary malignancies (SPMs) are often underreported and overlooked as a significant concern.To date, only a few studies have addressed this issue in the context of GAC. These studies, however, are limited by their small patient cohorts and lack of substantial, meaningful findings. Our study aims to fill this gap by investigating the incidence, risk factors, and prognostic significance of SPMs among GAC survivors. Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we analysed data from patients diagnosed with GAC between 2000 and 2020. The study employs the standardized incidence ratio (SIR) to assess the relative risk of SPMs, competing risk regression to identify risk factors for SPM development after GAC, and Kaplan-Meier and COX regression analyses for survival outcomes. Out of 44,041 GAC patients analyzed, 2,032 (4.3%) developed SPMs, with a median latency period of 36 months. The incidence of SPMs was significantly higher in GAC patients (SIR 1.36, 95% CI 1.32-1.4, EAR 53.57) compared to the general population. Key factors including older age, sex, tumor grade, summary stage, and history of surgical and radiation therapy were related to the higher risk of developing SPMs following GAC. Interestingly, GAC patients without SPMs exhibited poorer overall survival compared to those with SPMs. Age, summary stage, and surgical history were identified as independent prognostic factors for GAC patients with SPMs. This comprehensive analysis underscores the necessity of vigilant monitoring and tailored follow-up for SPMs in GAC survivors, highlighting the study's contribution to enhancing GAC survivors care strategies.
由于胃腺癌（GAC）患者的长期生存率较低，第二原发恶性肿瘤（SPM）的发生和预后往往被低估和忽视。迄今为止，只有少数研究在 GAC 背景下探讨了这一问题。然而，这些研究受到患者队列规模小且缺乏实质性有意义发现的限制。我们的研究旨在通过调查 GAC 幸存者中 SPM 的发生率、危险因素和预后意义来填补这一空白。我们利用监测、流行病学和最终结果（SEER）数据库，分析了 2000 年至 2020 年间诊断为 GAC 的患者数据。该研究采用标准化发病比（SIR）评估 SPM 的相对风险，采用竞争风险回归识别 GAC 后 SPM 发展的危险因素，采用 Kaplan-Meier 和 COX 回归分析生存结果。在分析的 44041 例 GAC 患者中，2032 例（4.3%）发生了 SPM，潜伏期中位数为 36 个月。与普通人群相比，GAC 患者 SPM 的发生率显著更高（SIR 1.36，95%CI 1.32-1.4，EAR 53.57）。年龄较大、性别、肿瘤分级、总结分期以及手术和放疗史等关键因素与 GAC 后发生 SPM 的风险增加相关。有趣的是，与无 SPM 的 GAC 患者相比，有 SPM 的 GAC 患者的总体生存率较差。年龄、总结分期和手术史被确定为有 SPM 的 GAC 患者的独立预后因素。这项综合分析强调了在 GAC 幸存者中对 SPM 进行警惕监测和个体化随访的必要性，突出了该研究对增强 GAC 幸存者护理策略的贡献。
