Curtis R E, Hoover R N, Kleinerman R A, Harvey E B
Natl Cancer Inst Monogr. 1985 Dec;68:113-37.
The risk of second primary cancer was evaluated in more than 25,000 women with cancer of the genital organs diagnosed between 1935 and 1982 in Connecticut. Significant excesses of subsequent cancers were observed following cancers of the cervix (35%, n = 656), uterine corpus (16%, n = 1,060), and ovary (58%, n = 366). When observed and expected second cancers of the female genital tract were excluded, these excesses became 40%, 30%, and 59% after cervix, uterine corpus, and ovary, respectively. Among women with either cancer of the cervix or uterine corpus, the risk of developing a second cancer rose with increasing duration of follow-up, reaching an excess of 61 and 34%, respectively, after 20 years. In contrast, among patients with ovarian cancer, the second cancer risk decreased over time to 41% after 10 years. Cancers related to smoking, i.e., oral cavity and pharynx, esophagus, and respiratory system, were notably increased among cervical cancer patients. The twofold to threefold risks observed for these second cancers are consistent with recent evidence linking cervical cancer to cigarette smoking and seem too large to be artifacts of confounding by low socioeconomic status. An increased incidence of second cancer of the abdominal organs (colon, rectum, kidney, bladder, ovaries) was generally observed for each gynecologic site. However, only rectal cancer was consistently linked with radiation treatment for the first primary cancer. Leukemia occurred in excess after cancers of the uterine corpus and ovary, but not after cervical cancer. The predominant cell type was acute nonlymphocytic leukemia, and the excess was associated with radiotherapy for uterine corpus cancer and with chemotherapy for ovarian cancer. Cancers of the breast and colon were increased following uterine corpus and ovarian cancer and vice versa, which supports the notion that these sites share a common etiology, perhaps related to dietary or hormonal factors. Cervical cancer patients experienced a deficit of subsequent breast cancer, possibly due to ovarian removal or ablation by radiation. Investigators need to explore further the association between the smoking-related cancer sites and cervical cancer, to clarify the role of radiotherapy and chemotherapy in relation to excess cancers, and to define more fully the etiologic factors that link cancers of the breast, colon, uterine corpus, and ovary.
对1935年至1982年间在康涅狄格州诊断出患有生殖器官癌症的25000多名女性的第二原发性癌症风险进行了评估。在子宫颈癌（35%，n = 656）、子宫体癌（16%，n = 1060）和卵巢癌（58%，n = 366）之后，观察到后续癌症有显著增加。当排除女性生殖道的观察到的和预期的第二癌症后，子宫颈癌、子宫体癌和卵巢癌之后的这些增加分别变为40%、30%和59%。在患有子宫颈癌或子宫体癌的女性中，患第二癌症的风险随着随访时间的延长而增加，20年后分别达到61%和34%的超额风险。相比之下，在卵巢癌患者中，第二癌症风险随时间下降，10年后降至41%。在子宫颈癌患者中，与吸烟相关的癌症，即口腔和咽部、食管以及呼吸系统的癌症显著增加。这些第二癌症观察到的两倍至三倍风险与最近将子宫颈癌与吸烟联系起来的证据一致，而且似乎太大而不太可能是低社会经济地位造成混杂的假象。对于每个妇科部位，一般都观察到腹部器官（结肠、直肠、肾脏、膀胱、卵巢）第二癌症的发病率增加。然而，只有直肠癌始终与对第一原发性癌症的放射治疗有关。白血病在子宫体癌和卵巢癌之后出现超额，但在子宫颈癌之后没有。主要细胞类型是急性非淋巴细胞白血病，超额与子宫体癌的放射治疗以及卵巢癌的化疗有关。子宫体癌和卵巢癌之后乳腺癌和结肠癌增加，反之亦然，这支持了这些部位有共同病因的观点，可能与饮食或激素因素有关。子宫颈癌患者后续乳腺癌出现不足，可能是由于卵巢切除或放射消融。研究人员需要进一步探索与吸烟相关的癌症部位与子宫颈癌之间的关联，阐明放射治疗和化疗与超额癌症的关系，并更全面地确定将乳腺癌、结肠癌、子宫体癌和卵巢癌联系起来的病因因素。
