背景:发展为后续原发癌(SPC)的癌症幸存者数量有望增加。
目的:我们根据性别和年龄,通过第一原发癌(FPC)类型评估了成人发病癌症幸存者SPC的总体风险和癌症类型特异性风险。
方法:我们使用韩国的健康保险审查和评估数据库进行了一项回顾性队列研究,包括2009年至2010年诊断为FPC的5年癌症幸存者,并随访至2019年12月31日。我们测量了每10,000人年的SPC发病率和标准化发病率(SIR)与普通人群中预期的发病率相比。
结果:在266,241名幸存者中(FPC的平均年龄:55.7岁;149,352/266,241,56.1%的女性),7348SPC发生在1,003,008人年的随访期间(中位数4.3年),代表发生SPC的风险降低26%(SIR0.74,95%CI0.72-0.76)。总的来说,20种FPC类型中有14种的男性发生SPC的风险显著较低;21种FPC类型中有7种的女性发生SPC的风险显著较低.发展任何SPC类型的风险因年龄而异;与相应年龄的一般人群相比,年轻(<40岁)癌症幸存者的风险高28%(SIR1.28,95%CI1.16-1.42;发病率:每10,000人年30人),而中年和老年(≥40岁)癌症幸存者的风险低27%(SIR0.73,95%CI0.71-0.74;发病率:每10,000人年80人最常见的FPCs类型主要是在癌症幸存者中观察到的SPCs,男性患有肺癌(21.6%)和前列腺癌(15.2%),女性患有乳腺癌(18.9%)和肺癌(12.2%)。结直肠癌幸存者患脑癌的风险,喉癌幸存者的肺癌,在甲状腺癌幸存者中,肾癌和白血病在男女中均显著升高。其他高风险SPC因FPC类型和性别而异。与吸烟有关的癌症之间有很强的正相关关系,比如喉部,头部和颈部,肺,和食道癌,被观察到。特定类型的FPC和特定类型的SPC风险之间的关联存在实质性差异,这可能与遗传性癌症综合征有关:对女性来说,乳腺癌幸存者患卵巢癌的风险和结直肠癌幸存者患子宫癌的风险,而对于男人来说,肾癌幸存者患胰腺癌的风险。
结论:SPC的风险因年龄而异,性别,癌症幸存者中的FPC类型意味着有必要针对癌症幸存者进行量身定制的预防和筛查计划。生活方式的修改,比如戒烟,对于降低癌症幸存者SPC的风险至关重要。此外,基因检测,以及积极的癌症筛查和预防策略,应该对年轻的癌症幸存者实施,因为他们患SPC的风险增加。
BACKGROUND: The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase.
OBJECTIVE: We evaluated the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age.
METHODS: We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population.
RESULTS: Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26% lower risk of developing SPCs (SIR 0.74, 95% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28% higher in young (<40 years) cancer survivors (SIR 1.28, 95% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27% lower in middle-aged and older (≥40 years) cancer survivors (SIR 0.73, 95% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6%) and prostate (15.2%) cancers in men and breast (18.9%) and lung (12.2%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors.
CONCLUSIONS: The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs.