Melku Mulugeta, Best Oliver G, Winter Jean M, Thurgood Lauren A, Ahmed Muktar, Kichenadasse Ganessan, Mittinty Murthy, Wassie Molla M, Symonds Erin L
Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Cancer Med. 2025 Jun;14(11):e70984. doi: 10.1002/cam4.70984.
Colorectal cancer (CRC) is the fourth most diagnosed cancer in Australia. With advancements in treatment and an increase in survival rates, CRC survivors face an elevated risk of developing multiple primary cancers (MPCs), presenting a clinical challenge. Therefore, this study aimed to estimate the incidence, trend and risk of MPCs after a diagnosis of CRC in the South Australian population.
This study analysed South Australian Cancer Registry data on individuals diagnosed with CRC as their first cancer from 1982 to 2017. The incidence of MPCs was assessed using cumulative incidence functions, and age-standardised rates were estimated. Poisson regression was used to determine the risk, and standardised incidence ratios (SIR) and absolute excess risks (AER) were estimated. Trends over time were analysed using Joinpoint regression.
The study included 26,729 CRC survivors. Of the cohort, 15% (3917) developed 4453 MPCs, with 96% diagnosed six or more months after index CRC. The cumulative incidence of MPCs was 22.5% (95% CI: 21.6-23.4). The median follow-up time until MPC diagnosis was 6.4 years. Common MPCs included prostate (18.9%), subsequent CRC (13.1%), lung (10.8%), haematological (10.2%) and breast (8.0%) cancers. The overall risk of MPCs was higher in CRC survivors (SIR: 1.12, 95% CI: 1.09-1.16; AER: 22.6 per 10,000) compared to the incidence in the general South Australian population. The incidence of MPCs has increased over time (annual percentage change = 1.95, 95% CI: 1.33-2.51).
CRC survivors are at increased risk of subsequent cancers, highlighting the need for targeted surveillance, particularly for prostate, lung, breast and blood cancers, for early detection and treatment.
结直肠癌（CRC）是澳大利亚第四大最常被诊断出的癌症。随着治疗方法的进步和生存率的提高，CRC幸存者患多发性原发性癌症（MPC）的风险升高，这带来了一项临床挑战。因此，本研究旨在估计南澳大利亚人群中CRC诊断后MPC的发病率、趋势和风险。
本研究分析了南澳大利亚癌症登记处关于1982年至2017年期间被诊断为CRC且为其首次患癌的个体的数据。使用累积发病率函数评估MPC的发病率，并估计年龄标准化率。采用泊松回归确定风险，并估计标准化发病率比（SIR）和绝对超额风险（AER）。使用Joinpoint回归分析随时间的趋势。
该研究纳入了26729名CRC幸存者。在该队列中，15%（3917人）发生了4453例MPC，其中96%在首次CRC诊断后6个月或更长时间被诊断出来。MPC的累积发病率为22.5%（95%CI：21.6 - 23.4）。直至MPC诊断的中位随访时间为6.4年。常见的MPC包括前列腺癌（18.9%）、后续CRC（13.1%）、肺癌（10.8%）、血液系统癌症（10.2%）和乳腺癌（8.0%）。与南澳大利亚普通人群的发病率相比，CRC幸存者中MPC的总体风险更高（SIR：1.12，95%CI：1.09 - 1.16；AER：每10000人中有22.6例）。MPC的发病率随时间增加（年度百分比变化 = 1.95，95%CI：1.33 - 2.51）。
CRC幸存者患后续癌症的风险增加，这凸显了进行针对性监测的必要性，尤其是针对前列腺癌、肺癌、乳腺癌和血液系统癌症，以便早期检测和治疗。
