Trends in the risk and burden of second primary malignancy among survivors of smoking-related cancers in the United States
Trends in the risk and burden of second primary malignancy among survivors of smoking-related cancers in the United States
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DOI：
10.1002/ijc.32101
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发表时间：
2019-07-01
影响因子：
6.4
通讯作者：
Piccirillo, Jay F.
中科院分区：
文献类型：
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作者：
Boakye, Eric Adjei;Buchanan, Paula;Piccirillo, Jay F.
虽然有越来越多的癌症幸存者，但这一人群发展为第二原发性恶性肿瘤（SPMs）的风险增加。我们描述了最常见的诊断为吸烟相关癌症的幸存者中SPM的发病率、最常见的肿瘤部位和负担趋势。目前的研究是一项基于人群的研究，研究对象是2000年至2014年间从监测、流行病学和最终结果数据中诊断为原发性恶性肿瘤的前10位吸烟相关癌症部位的患者。采用标准化发病率比（SIRs）和每10,000人年风险（PYR）的超额绝对风险（ear）对SPM风险进行量化。使用Joinpoint回归模型评估SPM负担的趋势。在一组1,608,607例患者中，119,980例（7.5%）发展为SPM（76%的SPM与吸烟有关）。与一般人群相比，发展为第二原发恶性肿瘤的总体SIR为1.51 (95% CI, 1.50-1.52)， EAR为每10,000 PYR 73.3例。头颈癌幸存者发生SPM的风险最高（SIR = 2.06），膀胱癌患者的额外负担最高（EAR = 151.4 / 10,000 PYR）。所有吸烟相关癌症的SPM超额负担在2000 - 2003年间下降（年百分比变化[APC] = -13.7%; p = 0.007），但在2003 - 2014年间略有上升（APC = 1.6%, p = 0.032）。我们发现，1 / 12的吸烟相关癌症幸存者患上了SPM。在过去十年中，吸烟相关癌症的SPM负担显著增加，临床医生应该认识到这些患者的长期吸烟相关癌症风险，并将其作为生存护理计划的一部分。
While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking-related cancers. The current study was a population-based study of patients diagnosed with a primary malignancy from the top 10 smoking-related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking-related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50-1.52) and the EAR was 73.3 cases per 10,000 PYR compared to the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR = 2.06) and urinary bladder cancer had the highest excess burden (EAR = 151.4 per 10,000 PYR). The excess burden of SPM for all smoking-related cancers decreased between 2000 and 2003 (annual percentage change [APC] = -13.7%; p = 0.007) but increased slightly between 2003 and 2014 (APC = 1.6%, p = 0.032). We show that 1-in-12 survivors of smoking-related cancers developed an SPM. With the significant increase in the burden of SPM from smoking-related cancers in the last decade, clinicians should be cognizant of long-term smoking-related cancer risks among these patients as part of their survivorship care plans.