Surveillance for second primary colorectal cancer after adjuvant chemotherapy: An analysis of intergroup 0089
Surveillance for second primary colorectal cancer after adjuvant chemotherapy: An analysis of intergroup 0089
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DOI：
10.7326/0003-4819-136-4-200202190-00005
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发表时间：
2002-02-19
影响因子：
39.2
通讯作者：
Haller, DG
中科院分区：
文献类型：
--
作者：
Green, RJ;Metlay, JP;Haller, DG
背景：与有腺瘤性息肉病史的患者相比，有结肠癌病史的患者中第二原发结直肠癌的发病率尚不清楚。目前尚不清楚息肉患者的结肠镜筛查指南是否适用于既往结肠癌患者。目的：确定局限性结肠癌治疗后第二原发结直肠癌的发生率，并将这一发生率与普通人群和高危患者中第一原发结直肠癌的发生率进行比较。设计：历史队列研究。背景：一项国际、以5-氟尿嘧啶为基础的辅助化疗治疗局限性结肠癌的多机构试验。研究对象：3278例切除的II期和III期结肠癌患者。测量指标：第二原发结直肠癌的发生情况和第二原发结直肠癌的发生率。结果：在15345人年的随访中发现42例第二原发浸润性结肠癌，5年的发病率为274/10万人年(95%CI，196~369/10万人年)，累积发病率为1.5%(CI，1.1%~2.0%)。这一比率与两个参考组的第一结肠癌发病率进行了比较：普通人群和因腺瘤性息肉病史而频繁接受结肠镜检查和息肉切除术的患者；标准化发病率分别为1.6(CI，1.2~2.2)和6.8(CI，2.7~22.0)。结论：尽管采取了密切的监测措施，第二原发结直肠癌的发病率仍然很高。
Background: The incidence of second primary colorectal cancer in patients with a history of colon cancer, compared with patients with a history of adenomatous polyps, is unknown. It is unclear whether guidelines for colonoscopy screening in patients with polyps are appropriate for patients with previous colon cancer.Objective: To determine the incidence of second primary colorectal cancer after treatment for localized colon cancer and to compare this incidence with that of first primary colorectal cancer in both the general population and high-risk patients.Design: Historical cohort study.Setting: An international, multi-institutional trial of adjuvant 5-fluorouracil-based chemotherapy for localized colon cancer.Patients: 3278 patients with resected stage II and stage III colon cancer.Measurements: Occurrence of endoscopic or radiologic colon surveillance and incidence of second primary colorectal cancer.Results: Forty-two cases of second primary invasive colon cancer were found over 15 345 person-years of follow-up, yielding an incidence rate of 274 per 100 000 person-years (95% Cl, 196 to 369 per 100 000 person-years) and a cumulative incidence of 1.5% (CI, 1.1% to 2.0%) at 5 years. This rate was compared with rates of first colon cancer in two reference groups: the general population and patients who had undergone frequent colonoscopy and polypectomy because of a history of adenomatous polyps; standardized incidence ratios were 1.6 (Cl, 1.2 to 2.2) and 6.8 (Cl, 2.7 to 22.0), respectively.Conclusion: The incidence of second primary colorectal cancer remains high despite intensive surveillance strategies.