Second cancers among 104,760 survivors of cervical cancer:: Evaluation of long-term risk
Second cancers among 104,760 survivors of cervical cancer:: Evaluation of long-term risk
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DOI：
10.1093/jnci/djm201
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发表时间：
2007-11-07
影响因子：
10.3
通讯作者：
Travis, Lois B.
中科院分区：
文献类型：
--
作者：
Chaturvedi, Anil K.;Engels, Eric A.;Travis, Lois B.
背景：考虑到宫颈癌患者的生存期延长，这些妇女中接受放疗的人数众多，以及在这一人群中存在已知的癌症危险因素，如人乳头瘤病毒（HPV）感染和吸烟，阐明二次癌症风险的长期趋势很重要。方法使用来自丹麦、芬兰、挪威、瑞典和美国13个基于人群的癌症登记处的104760名一年宫颈癌幸存者的数据，我们计算了宫颈癌妇女中第二种癌症和特定部位癌症的标准化发病率（SIRs），包括接受或未接受放射治疗的宫颈癌患者，超过40年的随访。Cox回归模型用于评估放射治疗与第二癌症风险的时变相关性，以及评估放射治疗与诊断年龄的相互作用。所有统计检验均为双侧检验。结果104760例宫颈癌1年存活患者中，所有二次癌合并发生的风险均有统计学意义的增加（n = 12496; SIR = 1.30； 95%可信区间[Cl] = 1.28 ~ 1.33）。与一般人群相比，在放疗组（N = 52 613）和非放疗组（N = 27382）中，hpv相关癌症（咽部、生殖器部位和直肠/肛门）和吸烟相关癌症（咽部、气管/支气管/肺、胰腺和膀胱）的风险均升高，具有统计学意义。与普通人群中的女性相比，接受放射治疗的宫颈癌患者，而不是未接受放射治疗的宫颈癌患者，在40年的随访中患所有第二癌和重度放射部位（结肠、直肠/肛门、膀胱、卵巢和生殖器部位）的癌症的风险增加。放疗与第二癌风险的关联随着直肠/肛门、生殖器部位和膀胱宫颈癌诊断的年龄而改变，宫颈癌患者年龄越小，第二癌风险比越高。在对竞争死亡率进行调整后，50岁前诊断为宫颈癌的女性40年累积患第二种癌症的风险（22.2%;95% Cl = 21.5%至22.8%）高于50岁后诊断为宫颈癌的女性（16.4%;95% Cl = 16.1%至16.9%）。结论放疗后宫颈癌患者近子宫颈部位继发风险增高，随访时间超过40年。
Background Given the extended survival of patients diagnosed with cervical cancer, the large number of these women treated with radiotherapy, and the presence in this population of established cancer risk factors such as human papillomavirus (HPV) infection and cigarette smoking, it is important to clarify long-term trends in second cancer risk.Methods Using data from 104760 one-year survivors of cervical cancer reported to 13 population-based cancer registries in Denmark, Finland, Norway, Sweden, and the United States, we calculated standardized incidence ratios (SIRs) for second cancers overall and cancers at particular sites among women with cervical cancer, including cervical cancer patients who were treated or not treated with radiation, over more than 40 years of follow-up. Cox regression models were used to assess the time-varying association of radiotherapy with risk of second cancers and to assess the interaction of radiation treatment with age at diagnosis. All statistical tests were two-sided.Results Among 104760 one-year survivors of cervical cancer, the risk of all second cancers taken together was increased to a statistically significant extent (n = 12 496; SIR = 1.30; 95% confidence interval [Cl] = 1.28 to 1.33). Compared with the general population, in both radiotherapy (N = 52 613) and no-radiotherapy groups (N = 27382), risks for HPV-related cancers (of the pharynx, genital sites, and rectum/anus) and smoking-related cancers (of the pharynx, trachea/bronchus/lung, pancreas, and urinary bladder) were elevated to a statistically significant extent. Cervical cancer patients treated with radiotherapy, but not those who did not receive radiotherapy, were at increased risk for all second cancers and cancers at heavily irradiated sites (colon, rectum/anus, urinary bladder, ovary, and genital sites) beyond 40 years of follow-up compared with women in the general population. The association of radiotherapy with second cancer risk was modified by age at cervical cancer diagnosis for rectum/anus, genital sites, and urinary bladder, with higher hazard ratios for second cancer at younger ages of cervical cancer. After adjustment for competing mortality, the 40-year cumulative risk of any second cancer was higher among women diagnosed with cervical cancer before age 50 (22.2%; 95% Cl = 21.5% to 22.8%) than among women diagnosed after age 50 (16.4%; 95% Cl = 16.1% to 16.9%).Conclusion Cervical cancer patients treated with radiotherapy are at increased risk of second cancers at sites in close proximity to the cervix beyond 40 years of follow-up.