Association between postoperative radiotherapy for young-onset head and neck cancer and long-term risk of second primary malignancy: a population-based study.
Association between postoperative radiotherapy for young-onset head and neck cancer and long-term risk of second primary malignancy: a population-based study.
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DOI：
10.1186/s12967-022-03544-y
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发表时间：
2022-09-05
影响因子：
7.4
通讯作者：
Tao, Lei
中科院分区：
文献类型：
--
作者：
Zhu, Xiaoke;Zhou, Jian;Zhou, Liang;Zhang, Ming;Gao, Chunli;Tao, Lei
关键词：
第二原发恶性肿瘤（SPM）是头颈部鳞状细胞癌（HNSCC）患者长期死亡的主要原因。我们的目的是量化青少年和年轻患者的术后放疗（PORT）与指数HNSCC SPM发展风险之间的关系，由于他们的组织易感性增加和预期寿命延长，他们特别容易受到辐射相关的影响。本研究采用监测、流行病学和最终结果（SEER）数据库，收集1975年至2011年指数早发型HNSCC 5年幸存者的数据。结果感兴趣的是SPM，一个新的，异时恶性肿瘤后指数HNSCC。外部采用标准化发生率比（SIRs）和超额绝对风险（ear）来量化port相关风险，内部采用多变量泊松回归分析估算相对风险（rr）来量化port相关风险。在纳入的2771例指数早发型HNSCCs的5年幸存者中，接受PORT（37.6%）与SPMs的高风险相关（RR, 1.23; 95% CI 1.07至1.43）。大多数部位的port相关风险升高，包括头颈部（RR, 1.19; 95% CI 0.95 - 1.50）和肺部（RR, 1.67; 95% CI 1.18 - 2.34）。对于头颈部亚位点，口腔鳞状细胞癌（SCC） （RR, 1.68; 95% CI 1.39 ~ 2.03）和喉部鳞状细胞癌（RR, 1.02; 95% CI 0.73 ~ 1.43）的相对危险度均在统一以上。年龄小于35岁的患者（RR, 1.44, 95% CI 0.37 ~ 5.57）和诊断为局限性疾病的患者（RR, 1.16, 95% CI 0.9 ~ 1.5）的RR相对较大。随访15年后，port相关风险显著增加（RR, 1.24; 95% CI 0.97 ~ 1.58）。发现PORT治疗与指数早发型HNSCC患者SPM长期风险增加之间存在关联。研究结果建议对这些患者进行长期随访监测，特别是那些口腔鳞状细胞癌或喉部鳞状细胞癌。在线版本包含补充材料，可在10.1186/s12967-022-03544-y获得。
Second primary malignancy (SPM) represents the leading long-term cause of death among patients with index head and neck squamous cell carcinoma (HNSCC). We aimed to quantify the association between postoperative radiotherapy (PORT) and the risk of SPM development for index HNSCC among adolescent and young patients, who are particularly vulnerable to radiation-associated impacts due to their increased tissue susceptibilities and longer life expectancies. This study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of 5 year survivors of index young-onset HNSCC from 1975 to 2011. The outcome of interest was SPM, a new, metachronous malignancy after the index HNSCC. Standardized incidence ratios (SIRs) and excess absolute risks (EARs) were used to quantify the PORT-associated risks externally, and relative risks (RRs) were estimated by the multivariate Poisson regression analysis to quantify the PORT-associated risks internally. Of the included 2771 5 year survivors with index young-onset HNSCCs, the receipt of PORT (37.6%) was associated with higher risk of SPMs (RR, 1.23; 95% CI 1.07 to 1.43). PORT-associated risks were elevated for the majority of sites, including head and neck (RR, 1.19; 95% CI 0.95 to 1.50) and lung (RR, 1.67; 95% CI 1.18 to 2.34). With regarding to the subsites of head and neck, RRs were above unity in oral cavity squamous cell carcinoma (SCC) (RR, 1.68; 95% CI 1.39 to 2.03) and laryngeal SCC (RR, 1.02; 95% CI 0.73 to 1.43). A relatively greater RR was observed for patients younger than 35 years (RR, 1.44, 95% CI 0.37 to 5.57) and those diagnosed with localized diseases (RR, 1.16, 95% CI 0.9 to 1.5). PORT-associated risks were increased remarkably after 15 years of follow-up (RR, 1.24; 95% CI 0.97 to 1.58). An association was discovered between PORT treatment and increased long-term risk of SPM among patients with index young-onset HNSCC. The findings suggest long-term follow-up surveillance for these patients, particularly those with oral cavity SCC or laryngeal SCC. The online version contains supplementary material available at 10.1186/s12967-022-03544-y.
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