Second Primary Malignancies in Patients with Colorectal Cancer: A Population-Based Analysis
Second Primary Malignancies in Patients with Colorectal Cancer: A Population-Based Analysis
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DOI：
10.1634/theoncologist.2019-0266
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发表时间：
2020-01-14
期刊：
影响因子：
5.8
通讯作者：
Wu, Zhenyu
中科院分区：
文献类型：
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作者：
Jia, Huixun;Li, Qingguo;Wu, Zhenyu
目的探讨结直肠癌(CRC)伴发第二原发癌(SPM)患者的临床特点，以明确第二原发癌的高危人群。方法我们回顾了来自监测、流行病学和最终结果(SEER)数据库的20-79岁结直肠癌患者的资料。符合条件的患者仅被归类为一种原发恶性肿瘤和SPM队列。竞争风险模型被用来量化SPM的发生和患者的多种特征之间的关联。最后，使用决策曲线分析(DCA)通过计算净收益来评估该模型的临床实用性。结果总共鉴定出179,884名患者，其中18,285名(10.2%)在最长约18年的随访期内发生了SPMS。第二次诊断后的中位生存期不到4年。发生SPM的3年、5年和10年累积风险分别为3.9%、5.9%和10.0%。根据多变量竞争风险模型，接受手术治疗的男性结肠癌幸存者，年龄较大，肿瘤分化良好，有局限性疾病，容易感染SPM。DCA产生了广泛的风险阈值，在这些阈值下，我们建议的模型将获得净收益。结论结直肠癌存活者仍有发生结直肠癌的高风险。第二次被诊断为癌症的患者不仅存活率显著下降，而且癌症特异性死亡率也较高。还提供了一个基于网络的个性化预测工具，以帮助临床医生识别患有SPM的高危患者，并计划他们未来的护理管理。实践中的启示：结直肠癌幸存者仍有发生第二种原发恶性肿瘤(SPM)的高风险。本研究旨在了解结直肠癌合并第二原发癌患者的特点，并利用大规模人群队列进一步探讨与第二原发癌发生相关的危险因素。开发了一个临床上有用的竞争风险诺模图，以根据个别临床因素预测SPMS的风险。根据研究结果，结肠癌患者中年龄较大、男性、白人或黑人、局部疾病和手术治疗与发生SPM的风险增加相关。这些发现和建议的工具可能对临床医生和护理人员在结直肠癌患者的临床咨询和发展长期护理管理方面有用。
Purpose This study aimed to profile the characteristics of patients with colorectal cancer (CRC) with a second primary malignancy (SPM) and to identify patients with CRC at high risk of developing SPMs. Methods We retrospectively reviewed data on patients with CRC aged 20-79 years from the Surveillance, Epidemiology, and End Results (SEER) database. Eligible patients were categorized into only one primary malignancy and SPM cohorts. A competing-risk model was used to quantify associations between SPM occurrence and the multiple traits of patients. Finally, a decision curve analysis (DCA) was used to evaluate the clinical usefulness of the model by calculating net benefit. Results A total of 179,884 patients were identified, 18,285 (10.2%) of whom developed SPMs during a maximum follow-up of approximately 18 years. The median survival time after the second diagnosis was less than 4 years. The 3-year, 5-year, and 10-year cumulative risks of developing an SPM were 3.9%, 5.9%, and 10.0%, respectively. According to the multivariable competing-risk model, male colon cancer survivors, older in age, with a well-differentiated tumor and localized disease, who were treated with surgery were susceptible to SPMs. The DCA yielded a wide range of risk thresholds at which the net benefits would be obtained from our proposed model. Conclusion CRC survivors remain at high risk of developing SPMs. Patients with a second diagnosis of cancer showed not only significantly worse survival but also higher cancer-specific mortality. A web-based individualized predictive tool was also provided to assist clinicians in identifying patients at high risk of developing SPMs and planning their future care management. Implications for Practice Colorectal cancer survivors remain at high risk of developing a second primary malignancy (SPM). This study aimed to profile the characteristics of patients with colorectal cancer with second primary malignancies and to further explore the risk factors related to the development of second primary malignancies, using a large population-based cohort. A clinically useful competing-risk nomogram was developed to predict the risk of SPMs based on individual clinical factors. According to the findings, older age, male sex, white or black race, localized disease, and treatment with surgery among patients with colon cancer were associated with an increased risk of developing an SPM. These findings and the proposed tool could be useful to clinicians and caregivers in the clinical counseling of patients with colorectal cancer and the development of long-term care management.