Second Primary Cancers After an Index Head and Neck Cancer: Subsite-Specific Trends in the Era of Human Papillomavirus-Associated Oropharyngeal Cancer
Second Primary Cancers After an Index Head and Neck Cancer: Subsite-Specific Trends in the Era of Human Papillomavirus-Associated Oropharyngeal Cancer
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DOI：
10.1200/jco.2010.31.8311
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发表时间：
2011-02-20
影响因子：
45.3
通讯作者：
Ganly, Ian
中科院分区：
文献类型：
--
作者：
Morris, Luc G. T.;Sikora, Andrew G.;Ganly, Ian
头颈部鳞状细胞癌（HNSCC）患者发生第二原发恶性肿瘤（SPM）的风险较高，最常见的是头颈部（HN）、肺和食管。我们的目标是确定HNSCC亚单位的SPM风险和分布的具体差异，并描述了超过30年的风险趋势，在人乳头瘤病毒（HPV）相关的口咽SCC.MethodsPopulation-based的队列研究的75,087例HNSCC患者的监测，流行病学和最终结果（SEER）计划。SPM风险通过使用标准化发病率比（SIR）、每10，000人-年风险（PYR）的超额绝对风险（EAR）和需要观察的人数进行量化。SPM风险的趋势进行了分析，通过使用joinpoint log-linear regression.ResultsIn HNSCC患者，第二原发性实体瘤的SIR为2.2（95%CI，2.1至2.2），和平均每10,000 PYR 167.7癌症。下咽部SCC的SPM风险最高（SIR，3.5; CRYSTAL，307.1/10，000 PYR），喉SCC的SPM风险最低（SIR，1.9; CRYSTAL，147.8/10，000 PYR）。口腔和口咽鳞癌患者最常见的SPM部位是HN;喉癌和下咽癌患者最常见的SPM部位是肺。自1991年以来，SPM的风险已显着降低口咽部鳞状细胞癌患者（每年的百分比变化，-4.6%，P = .03）。结论在HNSCC患者，SPM的风险和分布显着不同，根据子网站的索引癌症。在20世纪90年代之前，下咽癌和口咽癌的SPM超额风险最高。从那时起，在HPV时代，与口咽SCC相关的SPM风险已降至任何子位点的最低风险水平。
PurposePatients with head and neck squamous cell carcinoma (HNSCC) are at elevated risk of second primary malignancies (SPM), most commonly of the head and neck (HN), lung, and esophagus. Our objectives were to identify HNSCC subsite-specific differences in SPM risk and distribution and to describe trends in risk over 3 decades, before and during the era of human papillomavirus (HPV) - associated oropharyngeal SCC.MethodsPopulation-based cohort study of 75,087 patients with HNSCC in the Surveillance, Epidemiology, and End Results (SEER) program. SPM risk was quantified by using standardized incidence ratios (SIRs), excess absolute risk (EAR) per 10,000 person-years at risk (PYR), and number needed to observe. Trends in SPM risk were analyzed by using joinpoint log-linear regression.ResultsIn patients with HNSCC, the SIR of second primary solid tumor was 2.2 (95% CI, 2.1 to 2.2), and the EAR was 167.7 cancers per 10,000 PYR. The risk of SPM was highest for hypopharyngeal SCC (SIR, 3.5; EAR, 307.1 per 10,000 PYR) and lowest for laryngeal SCC (SIR, 1.9; EAR, 147.8 per 10,000 PYR). The most common SPM site for patients with oral cavity and oropharynx SCC was HN; for patients with laryngeal and hypopharyngeal cancer, it was the lung. Since 1991, SPM risk has decreased significantly among patients with oropharyngeal SCC (annual percentage change in EAR, -4.6%; P = .03).ConclusionIn patients with HNSCC, the risk and distribution of SPM differ significantly according to subsite of the index cancer. Before the 1990s, hypopharynx and oropharynx cancers carried the highest excess risk of SPM. Since then, during the HPV era, SPM risk associated with oropharyngeal SCC has declined to the lowest risk level of any subsite.