Edfelt Elias, Shahrivar Mehrnoosh, Holmsten Karin, Radkiewicz Cecilia
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Colorectal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Oncology, Capio Sankt Görans Hospital, Stockholm, Sweden.
Acta Oncol. 2025 Mar 7;64:374-379. doi: 10.2340/1651-226X.2025.42592.
There is a lack of comprehensive reports on time trends in synchronous prostate and rectal cancers. To address this, we conducted the largest cohort study to date to assess these trends in a population-based setting.
We included all adult (ages 18-99) men with incident prostate cancer in the Swedish Cancer Register in 1993-2019. Age-standardized incidence rates (ASIRs) of prostate cancer per 100,000 male population per year were calculated and compared to the ASIR of synchronous (± 6 months from rectal cancer diagnosis) prostate cancer. Age-adjusted synchronous-to-general incidence rate ratios (IRRs) were predicted using Poisson regression. As a sensitivity analysis to assess the effect of incidental findings due to the anatomical proximity, we investigated synchronous prostate and non-sigmoid colon cancers.
Among 238,252 prostate cancer cases, 594 were synchronous with rectal cancer. The incidence of synchronous prostate cancer increased over the study period, with mean ASIR rising from 418/100,000 (1993-2001) to 788/100,000 (year 2011-2019). The synchronous-to-general IRR increased from 1.92 (95% confidence interval (CI) 1.60-2.31) to 2.61 (95% CI 2.32-2.95) over the same periods. Prostate cancer was also more commonly diagnosed in conjunction with non-sigmoid colon cancer than in the overall male population, but no time trend was observed.
The incidence of synchronous prostate and rectal cancers has increased over the past 20 years in Sweden, with no signs of plateauing. Future studies are warranted to explore factors contributing to prostate cancer overdiagnosis and to optimize clinical management strategies for this complex patient group.
目前缺乏关于同步性前列腺癌和直肠癌时间趋势的全面报告。为解决这一问题，我们开展了迄今为止规模最大的队列研究，以评估基于人群环境中的这些趋势。
我们纳入了1993年至2019年瑞典癌症登记处中所有成年（18 - 99岁）前列腺癌新发病例。计算每年每10万男性人群中前列腺癌的年龄标准化发病率（ASIRs），并与同步性（直肠癌诊断前后±6个月）前列腺癌的ASIR进行比较。使用泊松回归预测年龄调整后的同步性与总体发病率比（IRRs）。作为评估因解剖位置接近导致偶然发现影响的敏感性分析，我们研究了同步性前列腺癌和非乙状结肠癌。
在238,252例前列腺癌病例中，594例与直肠癌同步发生。在研究期间，同步性前列腺癌的发病率有所上升，平均ASIR从418/10万（1993 - 2001年）升至788/10万（2011 - 2019年）。同期，同步性与总体发病率比从1.92（95%置信区间（CI）1.60 - 2.31）增至2.61（95%CI 2.32 - 2.95）。前列腺癌与非乙状结肠癌同时诊断的情况也比总体男性人群更为常见，但未观察到时间趋势。
在瑞典，过去20年中同步性前列腺癌和直肠癌的发病率有所上升，且无趋于平稳的迹象。有必要开展进一步研究，以探究导致前列腺癌过度诊断的因素，并优化针对这一复杂患者群体的临床管理策略。
