2ND MALIGNANCIES FOLLOWING TESTICULAR CANCER, OVARIAN-CANCER AND HODGKINS-DISEASE - AN INTERNATIONAL COLLABORATIVE STUDY AMONG CANCER REGISTRIES
2ND MALIGNANCIES FOLLOWING TESTICULAR CANCER, OVARIAN-CANCER AND HODGKINS-DISEASE - AN INTERNATIONAL COLLABORATIVE STUDY AMONG CANCER REGISTRIES
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DOI：
10.1002/ijc.2910390506
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发表时间：
1987-05-15
影响因子：
6.4
通讯作者：
STORM, HH
中科院分区：
文献类型：
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作者：
KALDOR, JM;DAY, NE;STORM, HH
11个基于人群的癌症登记处列出了1945年至1984年期间诊断为睾丸癌、卵巢癌或霍奇金病的133，411名患者中的第二种癌症。总体而言，观察到3，157例第二次癌症，而第一次癌症至少一年后预计为2，420例。睾丸癌和卵巢癌的幸存者经历的癌症分别比一般人群对照组多30%和20%，先前诊断为霍奇金病的患者的癌症多出80%。没有关于首次癌症治疗或其他风险因素的信息。然而，分析了特定第二种癌症风险的时间模式，特别是对第一种癌症治疗的可能作用。急性或非淋巴型白血病（以前与烷化剂治疗有关）在所有3种首发癌症后发生率均超过非霍奇金淋巴瘤（总体相对危险度分别为6.1和1.8，霍奇金病后的相对危险度明显更高）。其他发生重要且可能的治疗诱导过度的癌症是霍奇金病后的肺癌（相对风险1.9），霍奇金病后的乳腺癌（相对风险1.4）和卵巢癌和霍奇金病后的膀胱癌（女性的相对风险分别为1.7和2.2）。唾液腺、甲状腺、骨骼和结缔组织中发生明显过量的部位较少。在卵巢癌和睾丸癌之后，直肠癌和结肠癌，霍奇金病之后的皮肤癌，以及卵巢癌之后的肾癌，都有较小但明显的过度。过度诊断、转移的错误分类和其他危险因素的混淆都被认为是观察到的过度的解释。尽管如此，除急性白血病以外的其他癌症似乎存在明显的过度风险，这必须归因于对第一种癌症的治疗，特别是考虑到登记资料中可能存在报告不足的情况。正在进行病例对照研究，以提供关于治疗的具体方面的作用的信息。
Eleven population-based cancer registries tabulated second cancers among 133,411 patients diagnosed with testicular cancer, ovarian cancer or Hodgkin''s disease between 1945 and 1984. Overall, 3,157 second cancers were observed, as compared with 2,420 expected at least one year after the first cancer. Survivors of testicular and ovarian cancer experienced 30% and 20% more cancers respectively than the general population comparison group, and patients previously diagnosed with Hodgkin''s disease had an 80% excess of cancer. No information was available either on treatment for the first cancer, or other risk factors. However, temporal patterns in the risk of specific second cancers were analyzed, with particular reference to the possible role of therapy for the first cancer. Leukemia of the acute or non-lymphatic type, which has been previously linked to alkylating agent therapy, occurred in excess following all 3 first cancers, as did non-Hodgkin''s lymphoma (overall relative risks of 6.1 and 1.8 respectively, with considerably higher relative risks following Hodgkin''s disease). Other cancers for which important and plausibly therapy-induced excesses occurred were lung cancer following Hodgkin''s disease (relative risk 1.9), breast cancer following Hodgkin''s disease (relative risk 1.4) and bladder cancer following ovarian cancer and Hodgkin''s disease (relative risks 1.7 and 2.2 in women, respectively). Rarer sites at which striking excesses occurred were the salivary gland, thyroid, bone and connective tissue. There were smaller, but clear excesses for cancers of the rectum and colon following ovarian cancer and testicular cancer, skin cancer following Hodgkin''s disease, and kidney cancer following ovarian cancer. Over-diagnosis, misclassification of metastases and confounding by other risk factors were all considered as explanations of observed excesses. Nonetheless, it appeared that there are clear excess risks for cancers other than acute leukemia which must be ascribed to therapy for the first cancer, especially in view of the possible under-reporting in registry material. Case-control studies are under way to provide information on the role of specific aspects of therapy.