Second Primary Cancers in Subsites of Colon and Rectum in Patients With Previous Colorectal Cancer
Second Primary Cancers in Subsites of Colon and Rectum in Patients With Previous Colorectal Cancer
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DOI：
10.1097/dcr.0b013e318279eb30
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发表时间：
2013-02-01
影响因子：
3.9
通讯作者：
Soerjomataram, Isabelle
中科院分区：
文献类型：
--
作者：
Liu, Lifang;Lemmens, Valery E. P. P.;Soerjomataram, Isabelle
背景技术背景：与一般人群相比，既往结直肠癌患者发生第二次结直肠癌的风险更高，但亚位点的详细风险分析很少。目的：我们的目标是调查与亚位点相关的第二次癌症风险，作为计划监测策略的基础。这是一项前瞻性设计、基于人群的癌症登记研究（荷兰癌症登记研究）的回顾性分析。纳入1989年至2008年诊断为I、II或II期结直肠癌的患者。在随访期2 - 5，6 - 10，结果：1989年至2008年期间，共有123,347例患者首次确诊为浸润性结直肠癌，其中50岁以上患者和50岁以下患者的首次确诊时间超过10年。其中，1849例患者（1.5%）在首次癌症后超过1年发现第二次结直肠病变，并被诊断为第二原发性结直肠癌。在50岁以上的患者中，近端结肠、远端结肠和直肠的第二次癌症的20年累积发病率分别为3.4%、1.2%和1.2%。超过60%的第二次癌症发生在癌症发生后的5年内。近端结肠的标准化发病率最高（1.9; 95% CI，1.8-2.0），其次是远端结肠（1.0，95% CI，0.9-1.1）和直肠（0.9，95% CI，0.8-1.0）。相应的每10000人年的绝对超额风险在近端结肠为9，远端结肠为0.1，直肠为1。5年随访后，仅在近端结肠观察到风险升高。在50岁以下的患者中观察到类似的风险模式。近端结肠中第二种癌症的绝对超额风险随着时间的推移而增加。II期和IV期第二次癌症的比例从第一个5年随访期间的31%增加到10年随访后的38%。局限性：本研究的局限性包括缺乏关于息肉切除率和监测结肠镜检查间隔的数据。与一般人群相比，既往患有结直肠癌的个体在结肠和直肠的所有子部位发生第二种癌症的风险更高。在50岁以上的长期生存者中，风险仅在近端结肠中升高。应鼓励进一步的研究，以开发一个合适的监测方法，老年，高风险，长期的结直肠癌幸存者。
BACKGROUND: Compared with the general population, patients with a previous colorectal cancer are at higher risk for a second colorectal cancer, but detailed risk analysis by subsite is scarce.OBJECTIVE: Our goal was to investigate the risk of a second cancer in relation to subsite as a basis for planning surveillance strategies,.DESIGN, SETTING, AND PATIENTS: This was a retrospective analysis of a prospectively designed, population-based cancer registry (The Netherlands Cancer Registry). Patients with a stage I, II, or II colorectal cancer diagnosed between 1989 and 2008 were included.MAIN OUTCOME MEASURES: Cumulative incidence, standardized incidence ratio, and absolute excess risk for second primary cancers in subsites of the colon and rectum were estimated for follow-up periods of 2 to 5, 6 to 10, and more than 10 years after the index cancer in patients older than 50 years and in those aged 50 years or younger.RESULTS: A total of 123,347 patients had a first invasive colorectal cancer diagnosed between 1989 and 2008. Of these, 1849 patients (1.5%) had a second colorectal lesion that was found more than 1 year after the initial cancer and diagnosed as a second primary colorectal cancer. In patients older than 50 years, the 20-year cumulative incidence for second cancers was 3.4% in the proximal colon, 1.2% in the distal colon, and 1.2% in the rectum. More than 60% of second cancers occurred within 5 years after the index cancer. The standardized incidence ratio was highest in the proximal-colon (1.9; 95% CI, 1.8-2.0), followed by the distal-colon (1.0, 95% CI, 0.9-1.1), and the rectum (0.9, 95% CI, 0.8-1.0). The corresponding absolute excess risks per 10 000 person years were 9 in the proximal colon, 0.1 in the distal colon, and 1 in the rectum. After 5 years of follow-up, elevated risk was observed only in the proximal colon. A similar risk pattern was observed in patients younger than 50 years. The absolute excess risk for a second cancer in the proximal colon increased over time. The proportion of stage II and stage IV second cancers increased from 31% during the first 5 years of follow-up to 38% after 10 years of follow-up.LIMITATIONS: Limitations of this study included lack of data regarding polypectomy rates and interval of surveillance colonoscopies.CONCLUSIONS: Compared with the general population, individuals with previous colorectal cancer have a higher risk for a second cancer in all subsites of the colon and rectum. Among long-term survivors older than 50 years, risk remains elevated only in the proximal colon. Further studies should be encouraged to develop a suitable surveillance method for aging, high-risk, long-term colorectal cancer survivors.