Frisch M, Olsen J H, Melbye M
Epidemiology Research Unit, Danish Epidemiology Science Centre, State Serum Institute, Copenhagen.
Am J Epidemiol. 1994 Jul 1;140(1):12-9. doi: 10.1093/oxfordjournals.aje.a117154.
With the use of two different approaches to study multiple primaries in anal cancer patients, the authors sought clues to the etiology of anal cancer. Based on data from the Danish Cancer Registry for 1943-1989, previous cancers in 831 anal cancer patients were compared with cancers in 12,376 matched population controls, and subsequent cancers in 955 anal cancer patients were compared with expected numbers based on population rates. Overall, previous cancers were in excess among anal cancer patients (odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.3-2.1). Elevated risks were observed especially for the vulva/vagina (OR = 15.4, 95% CI 4.9-48.0), cervix (OR = 4.3, 95% CI 2.7-6.9), and lymphoma/leukemia (OR = 3.9, 95% CI 1.5-10.4). Subsequent cancers were also in excess (relative risk (RR) = 1.4, 95% CI 1.1-1.7), particularly for the lung (RR = 2.3, 95% CI 1.3-3.7), bladder (RR = 2.3, 95% CI 1.0-4.6), breast (RR = 2.0, 95% CI 1.2-3.3), vulva/vagina (RR = 12.3, 95% CI 4.0-28.7), and small intestine (two cases) (RR = 10.8, 95% CI 1.2-39.0). Colorectal cancers were reduced (RR = 0.3, 95% CI 0.1-0.9). The data support a multifactorial etiology for anal cancer, in which an infectious agent and smoking may be involved. The association with lymphatic/hematopoietic cancers may indicate a possible role for immunodeficiency in anal cancer development. Multiple cancers occurred predominantly in patients diagnosed with anal cancer at a young age (< 60 years), which raises the possibility of a genetic predisposition for some cases. The authors recommend that, in future hypothesis generating and hypothesis testing multiple cancer studies of rare malignancies, the combined study of cancer events both prior to and following an index cancer should be considered.
通过使用两种不同方法研究肛管癌患者的多原发癌，作者探寻肛管癌的病因线索。基于丹麦癌症登记处1943 - 1989年的数据，将831例肛管癌患者之前患有的癌症与12376例匹配的人群对照中的癌症进行比较，并将955例肛管癌患者后续发生的癌症与基于人群发病率的预期数量进行比较。总体而言，肛管癌患者中既往患癌情况更多（优势比（OR）= 1.7，95%置信区间（CI）1.3 - 2.1）。尤其在外阴/阴道（OR = 15.4，95% CI 4.9 - 48.0）、子宫颈（OR = 4.3，95% CI 2.7 - 6.9）以及淋巴瘤/白血病（OR = 3.9，95% CI 1.5 - 10.4）方面观察到风险升高。后续患癌情况也更多（相对风险（RR）= 1.4，95% CI 1.1 - 1.7），特别是在肺癌（RR = 2.3，95% CI 1.3 - 3.7）、膀胱癌（RR = 2.3，95% CI 1.0 - 4.6）、乳腺癌（RR = 2.0，95% CI 1.2 - 3.3）、外阴/阴道（RR = 12.3，95% CI 4.0 - 28.7）以及小肠（2例）（RR = 10.8，95% CI 1.2 - 39.0）方面。结直肠癌的风险降低（RR = 0.3，95% CI 0.1 - 0.9）。数据支持肛管癌的多因素病因，其中可能涉及感染因子和吸烟。与淋巴/造血系统癌症的关联可能表明免疫缺陷在肛管癌发生中可能起作用。多原发癌主要发生在年轻时（< 60岁）被诊断为肛管癌的患者中，这增加了某些病例存在遗传易感性的可能性。作者建议，在未来针对罕见恶性肿瘤的多癌研究中进行假设生成和假设检验时，应考虑对索引癌之前和之后的癌症事件进行联合研究。
