Wassberg C, Thörn M, Yuen J, Ringborg U, Hakulinen T
Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden.
Int J Cancer. 1999 Feb 9;80(4):511-5. doi: 10.1002/(sici)1097-0215(19990209)80:4<511::aid-ijc5>3.0.co;2-p.
We studied second primary cancer among 25,947 patients diagnosed with squamous cell carcinoma of the skin (SCC) in Sweden between 1958 and 1992. In total, 5,706 patients developed a second primary cancer at any site, compared with an expected number of 2,651 [standardized incidence ratio (SIR) = 2.15; 95% confidence interval (CI) = 2.10-2.21]. Men below 60 years of age at diagnosis of SCC had higher SIR (2.5; CI = 2.2-2.8) with the highest risk during the first year of follow-up (SIR = 9.2; CI = 6.9-12.2). If second primary SCC was excluded, the SIR was reduced to 1.30 (CI = 1.25-1.34); the relationships by sex, age and time since diagnosis remained similar. For skin cancer, the SIR for second SCC was markedly elevated (SIR = 15.6) and the risk of malignant melanoma was elevated 3-fold. Significantly increased risks were found for most second cancers in squamous cell epithelium: lip (SIR = 5.2), respiratory organs (SIR = 1.7), esophagus (SIR = 1.5), cervix uteri (SIR = 2.2), and vulva including vagina (SIR = 2.3). There was a generally increased risk of almost 2-fold for second cancer in hematopoietic or lymphoproliferative tissues. Slightly increased rates (SIR = 1.0-1.5) were seen for second tumors in digestive tissues. Finally, a high SIR (SIR = 5.5) was observed for second primary cancer in salivary glands. In conclusion, patients with SCC are at increased risk to develop new primary cancer, especially in skin, squamous cell epithelial and tobacco-related tissues. Common risk factors among the tumor types might explain our findings, however, an intrinsic susceptibility among SCC patients to develop cancer is also possible.
我们对1958年至1992年间在瑞典被诊断为皮肤鳞状细胞癌（SCC）的25947名患者中的第二原发性癌症进行了研究。总共有5706名患者在任何部位发生了第二原发性癌症，而预期数量为2651例[标准化发病率比（SIR）=2.15；95%置信区间（CI）=2.10 - 2.21]。在诊断为SCC时年龄低于60岁的男性SIR更高（2.5；CI = 2.2 - 2.8），在随访的第一年风险最高（SIR = 9.2；CI = 6.9 - 12.2）。如果排除第二原发性SCC，SIR降至1.30（CI = 1.25 - 1.34）；按性别、年龄和诊断后的时间划分的关系仍然相似。对于皮肤癌，第二原发性SCC的SIR显著升高（SIR = 15.6），恶性黑色素瘤的风险升高了3倍。在鳞状上皮细胞中，大多数第二原发性癌症的风险显著增加：唇部（SIR = 5.2）、呼吸器官（SIR = 1.7）、食管（SIR = 1.5）、子宫颈（SIR = 2.2）以及外阴包括阴道（SIR = 2.3）。造血或淋巴增殖组织中第二原发性癌症的风险总体上增加了近2倍。消化组织中第二原发性肿瘤的发生率略有增加（SIR = 1.0 - 1.5）。最后，唾液腺中第二原发性癌症的SIR较高（SIR = 5.5）。总之，SCC患者发生新原发性癌症的风险增加，尤其是在皮肤、鳞状上皮细胞和与烟草相关的组织中。肿瘤类型之间的共同风险因素可能解释了我们的研究结果，然而，SCC患者发生癌症的内在易感性也是有可能的。
