Hoar S K, Wilson J, Blot W J, McLaughlin J K, Winn D M, Kantor A F
Natl Cancer Inst Monogr. 1985 Dec;68:49-82.
The risk of developing a second primary cancer was evaluated in approximately 64,000 persons diagnosed with cancer of the digestive system in Connecticut during 1935-82. Significant excesses of all second cancers combined were observed following cancer of the esophagus (58 observed vs. 33 expected), small intestine (41 vs. 24), and colon (2,268 vs. 1,714). A slight excess of multiple primaries was observed following cancer of the liver and biliary tract (47 vs. 40). The observed number of second cancers was nearly equal to the expected number for persons initially diagnosed with cancers of the stomach (251 vs. 258), rectum (952 vs. 941), and pancreas (40 vs. 40). Persons with initial cancers of the small intestine, colon, and rectum also had excess second cancers arising primarily in the colon, which suggested the influence of common etiologic factors or possibly misclassified metastases in some. Shared dietary, socioeconomic, or hormonal factors may explain the excess of uterine and ovarian cancers among patients with colon cancer and the excess of breast cancer among patients with colon and rectal cancers. Oral and respiratory cancers occurred more frequently than expected in persons with an initial esophageal cancer, which is likely due to common risk factors of cigarette smoking or alcohol intake, or both. The elevations in cancer of the prostate among males with cancers of the esophagus, small intestine, colon, rectum, liver/biliary, and pancreas are probably artifacts associated with increased medical surveillance of cancer patients. The prostate cancer excesses were limited to the first year after diagnosis of the initial cancer or decreased over time for all but cancer of the colon and small intestines. Increased medical surveillance may also contribute to the excess renal and bladder cancers seen within 5 years of diagnosis of stomach cancer. Excesses were also seen for second pancreatic cancer among small intestine and liver/biliary cancer patients and second kidney and brain cancers among those with colon cancer. The deficits of stomach and rectal cancer among persons initially diagnosed with the same tumors, respectively, were anticipated because surgical removal of the organ is the primary form of treatment. Patients with rectal cancer also had deficits of stomach and pancreatic cancers. Future research should clarify the role of diet, alcohol, metabolic and endocrine factors, and host susceptibility on the risk of second neoplasms following cancer of the digestive system.
1935年至1982年间，在康涅狄格州约64,000名被诊断患有消化系统癌症的人群中，评估了发生第二种原发性癌症的风险。在食管癌（观察到58例，预期33例）、小肠癌（41例对24例）和结肠癌（2268例对1714例）之后，观察到所有第二种癌症合并出现显著超额。在肝癌和胆管癌之后观察到多种原发性癌症略有超额（47例对40例）。最初被诊断患有胃癌（251例对258例）、直肠癌（952例对941例）和胰腺癌（40例对40例）的人群中，观察到的第二种癌症数量几乎与预期数量相等。最初患有小肠癌、结肠癌和直肠癌的人群中，也有主要发生在结肠的第二种癌症超额，这表明存在共同病因因素的影响，或者在某些情况下可能存在转移分类错误。共同的饮食、社会经济或激素因素可能解释了结肠癌患者中子宫癌和卵巢癌的超额以及结肠癌和直肠癌患者中乳腺癌的超额。最初患有食管癌的人群中，口腔癌和呼吸道癌的发生频率高于预期，这可能是由于吸烟或饮酒或两者共同的常见风险因素所致。患有食管癌、小肠癌、结肠癌、直肠癌、肝癌/胆管癌和胰腺癌的男性中前列腺癌的增加可能是与癌症患者医疗监测增加相关的假象。前列腺癌的超额仅限于最初癌症诊断后的第一年，或者除结肠癌和小肠癌外随时间减少。医疗监测增加也可能导致胃癌诊断后5年内出现的肾癌和膀胱癌超额。小肠癌和肝癌/胆管癌患者中第二种胰腺癌以及结肠癌患者中第二种肾癌和脑癌也出现超额。最初分别被诊断患有相同肿瘤的人群中胃癌和直肠癌的不足是可以预期的，因为手术切除器官是主要的治疗形式。直肠癌患者中胃癌和胰腺癌也有不足。未来的研究应阐明饮食、酒精、代谢和内分泌因素以及宿主易感性在消化系统癌症后第二种肿瘤风险中的作用。
