Risk of second primary malignancy after esophagectomy for squamous cell carcinoma of the thoracic esophagus
Risk of second primary malignancy after esophagectomy for squamous cell carcinoma of the thoracic esophagus
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DOI：
10.1200/jco.2003.12.074
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发表时间：
2003-12-01
影响因子：
45.3
通讯作者：
Nakagawa, A
中科院分区：
文献类型：
--
作者：
Matsubara, T;Yamada, K;Nakagawa, A
目的：为了评估随后的恶性肿瘤的风险，食管切除术后的胸段食管鳞状细胞癌的建立一个足够的后续programmes.Patients和方法：我们统计分析了114例第二恶性肿瘤食管切除术后，在94 679例接受根治性切除术的临床因素。结果：第二恶性肿瘤的10年累积危险度为34.5%，总体相对危险度（RR）为2.98（95%CI，2.41 ~ 3.65）。头颈部癌的风险显著升高（RR，34.9; 95%CI，24.3至48.6），其次是肺癌（RR，3.24; 95%CI，1.89至5.19）和胃癌（RR，2.00; 95%CI，1.17至3.21）。多因素分析表明，影响后续恶性肿瘤风险的独立因素是食管切除术前检测到的其他恶性肿瘤的存在和以下任何因素：男性，饮酒和吸烟。在检测到后续恶性肿瘤后的5年生存率为45%。由于早期检测困难，后续头颈癌患者的预后明显较差。结论：食管切除术后患者后续发生上呼吸消化道癌症的风险非常高，尤其是头颈癌。强烈建议进行术后监测，特别是在食管切除术前有恶性肿瘤病史的患者。早期发现第二恶性肿瘤允许微创治疗，预后良好。(C)2003年，美国临床肿瘤学会。
Purpose: To assess the risk of subsequent malignancies after esophagectomy for squamous cell carcinoma of the thoracic esophagus for the establishment of an adequate follow-up program.Patients and Methods: We statistically analyzed clinical factors in 114 cases of second malignancy after esophagectomy that developed in 94 of 679 patients who underwent curative resection. The cancer incidence rates in the general population estimated by the Research Group for Population-Based Cancer Registration in Japan were used as standards for comparison.Results: The 10-year cumulative risk of second malignancy was 34.5%, and the overall relative risk (RR) was 2.98 (95% CI, 2.41 to 3.65). The risk of head and neck cancer was markedly elevated (RR, 34.9; 95% CI, 24.3 to 48.6), followed by the risks of lung cancer (RR, 3.24; 95% CI, 1.89 to 5.19) and stomach cancer (RR, 2.00; 95% CI, 1.17 to 3.21). Multifactor analysis demonstrated that independent factors affecting the risk of subsequent malignancies were presence of other malignancies detected before esophagectomy and any of the following factors: masculine sex, alcohol consumption, and smoking. The 5-year survival rate after detection of subsequent malignancy was 45%. The outcome in patients with subsequent head and neck cancer was significantly less favorable as a result of difficulty in early detection.Conclusion: Patients had a remarkably high risk of subsequent cancer of the upper aerodigestive tract after esophagectomy, in particular, head and neck cancer. Minute postoperative surveillance is strongly recommended, especially in patients with a history of malignancies before esophagectomy. Early detection of second malignancies allowed less invasive treatment with favorable outcome. (C) 2003 by American Society of Clinical Oncology.