Maji Suvendu, Ghosh Saurav K, Jha Jayesh K, Chaturvedi Vikram
Department of Surgical Oncology, Medical College, Kolkata, West Bengal, India.
J Cancer Res Ther. 2024 Apr 1;20(3):888-892. doi: 10.4103/jcrt.JCRT_1603_20. Epub 2023 Sep 21.
Multiple primary cancers once thought to be rare have become increasingly common as the lifespan of cancer survivors has increased with availability of better and more effective cancer treatment. However, their exact incidence is not known and data on their epidemiological characteristics are not available.
The aim of this study is to study the epidemiologic characteristics of multiple primary cancers in the eastern region of India.
The study was conducted in the Department of Surgical Oncology, Medical College, Kolkata, from 2017 to 2020 over a period of 3 years. All patients with a diagnosis of second primary as per International Agency for Research on Cancer (IARC) definition or those developing a second primary within the study period were included for analysis. Data were recorded in form of preformed questionnaires. All the cases were followed up for at least 12 months.
Fifty cases of multiple primary tumors were identified, out of which 21 were synchronous while rest 29 were metachronous type. The male-female ratio was 1:1.2. The median age at presentation for index malignancy was 50 years. The most common malignancy in the synchronous group was a combination of variety of GI cancers (six cases). In the metachronous category, a combination of reproductive cancers (breast, ovary, cervix, and endometrium) along with Gastrointestinal cancer (GI) cancers (colon, rectum) was most frequently found (eight cases). Definite risk factors for multiple primary tumors were identifiable in 10 cases: arsenic exposure in 5 cases, hereditary in 4 cases, and immunosuppression in 1, while in 8 cases, risk factors were only speculative (radiation 5 cases, chemotherapy 3). At the time of the last follow-up, 36 subjects were alive and 3 dead while the status of 11 subjects was unknown.
This is the first comprehensive study on multiple primary cancers and the largest so far in India. Our study overcomes the shortcoming of previous case series from our subcontinent. The merits of our study include the use of the most accepted IARC definition, updated staging guidelines with long follow-up, and reliable survival data. Additionally, we could identify risk factors in 50% of our subjects. And our study shows various new combinations of cancers not reported before. Clustering of cases in the young adolescent group (25-49) years is also a new finding. We also highlight the existing ambiguity in the way this entity is defined. Demerits include the loss of follow-up data in a significant number of patients.
随着癌症幸存者寿命因更好、更有效的癌症治疗方法的出现而延长，曾经被认为罕见的多原发性癌症变得越来越常见。然而，其确切发病率尚不清楚，且缺乏关于其流行病学特征的数据。
本研究旨在探讨印度东部地区多原发性癌症的流行病学特征。
本研究于2017年至2020年在加尔各答医学院外科肿瘤学系进行，为期3年。所有根据国际癌症研究机构（IARC）定义诊断为第二原发性癌症的患者，或在研究期间发生第二原发性癌症的患者均纳入分析。数据以预先设计的问卷形式记录。所有病例均随访至少12个月。
共识别出50例多原发性肿瘤病例，其中21例为同步性，其余29例为异时性。男女比例为1:1.2。首发恶性肿瘤的中位发病年龄为50岁。同步性组中最常见的恶性肿瘤是多种胃肠道癌症的组合（6例）。在异时性类别中，生殖系统癌症（乳腺癌、卵巢癌、宫颈癌和子宫内膜癌）与胃肠道癌症（结肠癌、直肠癌）的组合最为常见（8例）。10例患者可确定多原发性肿瘤的明确危险因素：5例砷暴露、4例遗传因素和1例免疫抑制，而8例患者的危险因素仅为推测性（5例辐射、3例化疗）。在最后一次随访时，36例患者存活，3例死亡，11例患者情况不明。
这是印度首例关于多原发性癌症的综合性研究，也是迄今为止规模最大的研究。我们的研究克服了来自我们次大陆以前病例系列的缺点。我们研究的优点包括使用最被认可的IARC定义、更新的分期指南以及长期随访和可靠的生存数据。此外，我们能够在50%的受试者中识别出危险因素。我们的研究显示了以前未报告的各种新的癌症组合。青少年组（25 - 49岁）病例的聚集也是一项新发现。我们还强调了该实体定义方式中现有的模糊性。缺点包括大量患者随访数据缺失。
