Hemade Ali, Hallit Souheil
Faculty of Medicine, Lebanese University, Hadat, Lebanon.
School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Ann Med Surg (Lond). 2024 Oct 24;86(12):6944-6950. doi: 10.1097/MS9.0000000000002695. eCollection 2024 Dec.
The development of second primary cancers (SPCs) following a diagnosis of stomach cancer presents a significant clinical challenge, with varying risks depending on the anatomic subsite of the primary tumor, patient demographics, and treatment modalities. This study aims to assess the risk of SPCs in stomach cancer survivors, focusing on differences across anatomic subsites, sex, age, and treatment periods.
The authors conducted a retrospective cohort study using data from stomach cancer patients, analyzing the incidence of SPCs based on the anatomic location of the primary tumor, with stratifications by sex, age, latency period, and year of diagnosis. Standardized incidence ratios (SIRs) were calculated to compare the observed SPC rates with those expected in the general population.
Elevated stomach SPC risk was observed across most anatomic subsites, particularly in the body (SIR 8.84) and fundus (SIR 7.34). Females exhibited higher SIRs compared to males, especially in the fundus (SIR 13.33 for females vs. 4.55 for males). Younger patients (<50 years) had significantly higher SPC risks, particularly for cancers originating in the fundus (SIR 49.56). Notably, patients diagnosed after 2010 showed the highest SIRs, indicating a potential impact of advances in diagnostic and therapeutic modalities. Nonstomach SPCs, including colorectal, lung, and thyroid cancers, were significantly elevated, with distinct patterns based on the primary tumor site.
The study highlights the critical role of primary tumor location, sex, age, and treatment era in determining SPC risk in stomach cancer survivors. These findings underscore the need for tailored surveillance strategies to manage long-term cancer risks in this population.
胃癌诊断后发生第二原发性癌症（SPC）带来了重大的临床挑战，其风险因原发肿瘤的解剖部位、患者人口统计学特征和治疗方式而异。本研究旨在评估胃癌幸存者发生SPC的风险，重点关注解剖部位、性别、年龄和治疗时期的差异。
作者使用胃癌患者的数据进行了一项回顾性队列研究，根据原发肿瘤的解剖位置分析SPC的发病率，并按性别、年龄、潜伏期和诊断年份进行分层。计算标准化发病率（SIR）以比较观察到的SPC发生率与一般人群预期的发生率。
在大多数解剖部位观察到胃癌SPC风险升高，尤其是在胃体（SIR 8.84）和胃底（SIR 7.34）。女性的SIR高于男性，尤其是在胃底（女性SIR为13.33，男性为4.55）。年轻患者（<50岁）的SPC风险显著更高，尤其是起源于胃底的癌症（SIR 49.56）。值得注意的是，2010年后诊断的患者SIR最高，表明诊断和治疗方式的进步可能产生影响。非胃癌SPC，包括结直肠癌、肺癌和甲状腺癌，显著升高，且根据原发肿瘤部位有不同模式。
该研究强调了原发肿瘤位置、性别、年龄和治疗时代在确定胃癌幸存者SPC风险中的关键作用。这些发现强调了需要制定针对性的监测策略来管理该人群的长期癌症风险。
