Increased risk of rectal cancer after prostate radiation: A population-based study
Increased risk of rectal cancer after prostate radiation: A population-based study
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DOI：
10.1053/j.gastro.2004.12.038
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发表时间：
2005-04-01
期刊：
影响因子：
29.4
通讯作者：
Virnig, BA
中科院分区：
文献类型：
--
作者：
Baxter, NN;Tepper, JE;Virnig, BA
背景与目的：前列腺癌的放射治疗与盆腔恶性肿瘤，尤其是膀胱癌的发病率增加有关。放射治疗与结直肠癌之间的关系尚未确定。方法：我们利用1973年至1994年的监测、流行病学和最终结果(SEER)登记数据进行了一项回溯性队列研究。我们重点研究了前列腺癌患者，但之前没有结直肠癌病史，接受了手术或放射治疗，存活至少5年。我们评估了辐射对3个部位癌症发生的影响：明确照射部位(直肠)、潜在照射部位(直肠、乙状结肠和盲肠)和非照射部位(结肠的其余部分)。使用比例风险模型，我们评估了随着时间的推移辐射对结直肠癌发展的影响。结果：共有30552名男性接受了放射治疗，55263名男性只接受了手术。在1437名患者中发生了结直肠癌：267例发生在照射部位，686例发生在潜在照射部位，484例发生在非照射部位。随着时间的推移，辐射与受照射部位的癌症发展独立相关，但在结肠的其余部分则不相关。与单纯手术组相比，放疗组发生直肠癌的调整危险比为1.7(95%CI：1.4-2.2)。结论：我们注意到前列腺癌放射治疗后直肠癌的发生显著增加。辐射对结肠其余部分的癌症发展没有影响，表明这种影响是直接辐射组织所特有的。
Background& Aims: Radiation therapy for prostate cancer has been associated with an increased rate of pelvic malignancies, particularly bladder cancer. The association between radiation therapy and colorectal cancer has not been established. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data from :1973 through 1994. We focused on men with prostate cancer, but with no previous history of colorectal cancer, treated with either surgery or radiation who survived at least 5 years. We evaluated the effect of radiation on development of cancer for 3 sites: definitely irradiated sites (rectum), potentially irradiated sites (rectosigmoid, sigmoid, and cecum), and nonirradiated sites (the rest of the colon). Using a proportional hazards model, we evaluated the effect of radiation on development of colorectal cancer over time. Results: A total of 30,552 men received radiation, and 55,263 underwent surgery only. Colorectal cancers developed in 1437 patients: 267 in irradiated sites, 686 in potentially irradiated sites, and 484 in nonirradiated sites. Radiation was independently associated with development of cancer over time in irradiated sites but not in the remainder of the colon. The adjusted hazards ratio for development of rectal cancer was 1.7 for the radiation group, compared with the surgery-only group (95% CI: 1.4-2.2). Conclusions: We noted a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.