Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma
Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma
复制标题
DOI：
10.1001/jamaoto.2018.0993
复制
发表时间：
2018-08-01
影响因子：
7.8
通讯作者：
Piccirillo, Jay F.
中科院分区：
文献类型：
--
作者：
Boakye, Eric Adjei;Buchanan, Paula;Piccirillo, Jay F.
第二原发恶性肿瘤(SPMN)是头颈部鳞状细胞癌(HNSCC)幸存者死亡的主要原因。近年来，人乳头瘤病毒(HPV)已成为口咽鳞状细胞癌的危险因素，其预后与经典的烟/酒相关性HNSCC不同。这表明HNSCC患者之间可能存在不同的SPMN风险和负担，这些患者来自HPV或烟草和/或酒精。目的评估首次潜在HPV相关HNSCC与非HPV相关HNSCC患者中SPMN的风险和负担。设计：在这项以人群为基础的回顾性队列研究中，从监测、流行病学和最终结果登记中确定了2000年至2014年间确诊的109 512名成年HNSCC患者。患者被分成两组：潜在的HPV相关的HNSCC和非HPV相关的HNSCC。主要结果和衡量主要结果是SPMN的发生率(定义为在第一次癌症诊断后至少2个月后发生的第一次原发癌症)。使用相对(标化发病率[SIRS])和绝对(超额绝对风险[PYR])计算超额SPMN风险。结果共确诊109512例鼻咽癌患者(平均年龄61.9[12.1]岁；男性83305[76.196])。总体SIR为2.18(95%可信区间，2.14-2.22)，相当于每10000 PYR多出160例。首次潜在HPV相关性HNSCC患者的风险(SIR，1.98例；EAR，每10000 PYR额外病例114例)低于第一例非HPV相关HNSCC患者(SIR，2.28例；EAR，每10000 PYR额外病例188例)。总体而言，头颈部、肺癌和食道癌的SIRS和耳朵最大。然而，潜在的HPV相关性HNSCC患者发生SPMN的风险较低。结论被诊断为HNSCC的相关患者发生SPMN的风险过高，非HPV相关性HNSCC患者的SPMN风险高于潜在HPV相关性HNSCC患者。临床医生应在HNSCC患者中实施预防或早期发现SPMN的策略。
IMPORTANCE Second primary malignant neoplasms (SPMNs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Recently, human papillomavirus (HPV) has emerged as a risk factor for oropharyngeal squamous cell carcinoma and has different prognosis from classic tobacco/alcohol-associated HNSCC. This suggests that there also may be different risks and burden of SPMNs among patients who's HNSCC were from HPV or tobacco and/or alcohol.OBJECTIVE To assess SPMN risks and burden in a large US cohort of patients with a first potentially HPV-associated HNSCC vs non-HPV-associated HNSCC.DESIGN, SETTING, AND PARTICIPANTS In this population-based retrospective cohort study, 109 512 adult patients diagnosed with HNSCC between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results registry.EXPOSURES HPV-relatedness based on whether patients' first HNSCC was potentially associated with HPV. Patients were grouped into 2 cohorts: potentially HPV-associated HNSCC, and non-HPV-associated HNSCC.MAIN OUTCOMES AND MEASURES The primary outcome was incidence of SPMN (defined as the first subsequent primary cancer occurring at least 2 months after first cancer diagnosis). Excess SPMN risk was calculated using relative (standardized incidence ratios [SIRS]) and absolute (excess absolute risk [EAR] per 10 000 person-years at risk [PYR]).RESULTS A total of 109 512 patients with HNSCC (mean [SD] age, 61.9 [12.1] years; 83 305 [76.196] men) were identified. The overall SIR was 2.18 (95% CI, 2.14-2.22) corresponding to 160 excess cases per 10 000 PYR. The risk among patients with first potentially HPV-associated HNSCC (SIR, 1.98; EAR, 114 excess cases per 10 000 PYR) was lower than those with first non-HPV-associated HNSCC (SIR, 2.28; EAR, 188 excess cases per 10 000 PYR). Overall, the largest SIRS and EARs were observed for cancers of the head and neck, lung, and esophagus. However, the risks of SPMN were lower among potentially HPV-associated HNSCC patients.CONCLUSIONS AND RELEVANCE Patients diagnosed with HNSCC experience excess risk of SPMN, which was higher among those with non-HPV-associated HNSCC than from potentially HPV-associated HNSCC. Clinicians should implement strategies that prevent or detect SPMN early in patients with HNSCC.