Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China; Department of General Surgery, Xijing 986 Hospital, Fourth Military Medical University, Xi'an, China.
Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
Breast. 2024 Dec;78:103824. doi: 10.1016/j.breast.2024.103824. Epub 2024 Oct 19.
Radiotherapy (RT) for breast cancer (BC) may raise the risk of second primary cancers (SPCs), a relationship inadequately studied.
We analyzed 248268 female BC patients from 9 SEER registries, 1988-2018, identifying SPCs >5 years after initial treatment, comparing SPC risks between RT and non-RT cohorts using Fine-Gray and Poisson regressions.
Of all participants, 55.4 % received surgery and RT. The RT group had a higher SPC incidence, with excess incidence significantly dropped from 6.9 % in 1990 to 0.2 % in 2012. The 30-year SPC incidence was 24.69 % in the RT cohort and 18.11 % in the NRT cohort. RT increased the risk of SPCs(HR, 1.29 [95%CI,1.26-1.33]; P < 0.001), BC(HR, 1.58[1.52-1.64]; P < 0.001), cancer of respiratory system(HR, 1.21[1.13-1.30]; P = 0.013), skin cancer(HR, 1.26[1.10-1.44]; P < 0.001), leukemia(HR, 1.30[1.11-1.54]; P = 0.001), soft tissue cancer(HR, 1.78[1.34-2.37]; P < 0.001), and eye & orbit cancer(HR, 2.21[1.02-4.80]; P = 0.044), except for reducing the risk of multiple myeloma (HR 0.76). Notably, RT-related risks(RR) for BC declined with increasing age and the year of BC diagnosed, increased with longer latency, but the dynamic RR for cancer of respiratory system presented the almost opposite trends. The RT cohort had higher standardized incidence ratios for SPCs compared to both the NRT cohort and the general population overall. Although 15-year overall survival for SPCs was similar between RT and NRT cohorts, SPC presence significantly lowered 30-year survival from 35.64 % to 23.90 %.
RT might increase susceptibility to SPC in breast, respiratory system, skin, soft tissue, eye and orbit, and leukemia in BC survivors. Efforts should be made to timely diagnose SPCs based on their specific patterns to improve patient's quality of life.
乳腺癌（BC）放射治疗（RT）可能会增加第二原发癌（SPC）的风险，但这种关系尚未得到充分研究。
我们分析了来自 9 个 SEER 登记处的 248268 名女性 BC 患者，1988-2018 年，在初始治疗后 5 年以上识别 SPC，并使用 Fine-Gray 和泊松回归比较 RT 组和非 RT 组的 SPC 风险。
所有参与者中，55.4%接受了手术和 RT。RT 组 SPC 发生率较高，1990 年 excess incidence 为 6.9%，2012 年降至 0.2%。30 年 SPC 发生率为 RT 组 24.69%，NRT 组 18.11%。RT 增加了 SPC 的风险（HR，1.29[95%CI，1.26-1.33]；P<0.001），BC（HR，1.58[1.52-1.64]；P<0.001），呼吸道癌症（HR，1.21[1.13-1.30]；P=0.013），皮肤癌（HR，1.26[1.10-1.44]；P<0.001），白血病（HR，1.30[1.11-1.54]；P=0.001），软组织癌（HR，1.78[1.34-2.37]；P<0.001）和眼和眼眶癌（HR，2.21[1.02-4.80]；P=0.044），但降低了多发性骨髓瘤（HR 0.76）的风险。值得注意的是，BC 中 RT 相关风险（RR）随着年龄和 BC 诊断年份的增加而降低，随着潜伏期的延长而增加，但呼吸道癌症的动态 RR 呈现出几乎相反的趋势。与 NRT 队列和总体人群相比，RT 队列的 SPC 标准化发病率更高。尽管 RT 和 NRT 队列的 SPC 总生存时间相似，但 SPC 的存在使 30 年生存率从 35.64%降低至 23.90%。
RT 可能会增加 BC 幸存者中乳腺癌、呼吸道、皮肤、软组织、眼和眼眶以及白血病发生 SPC 的易感性。应根据其特定模式及时诊断 SPC，以提高患者的生活质量。
