Secondary Primary Malignancy Risk among Patients with Esophageal Cancer in Taiwan: A Nationwide Population-Based Study

作者：Chen San Chi; Teng Chung Jen^*; Hu Yu Wen; Yeh Chiu Mei; Hung Man Hsin; Hu Li Yu; Ku Fan Chen; Tzeng Cheng Hwai; Chiou Tzeon Jye; Chen Tzeng Ji; Liu Chia Jen

来源：PLos One, 2015, 10(1): e0116384.

DOI：10.1371/journal.pone.0116384

Background
To evaluate the risk and sites of metachronous secondary primary malignancies (SPMs) among patients with esophageal cancer.
Methods
Newly diagnosed esophageal cancer patients between 1997 and 2011 were recruited. To avoid surveillance bias, SPMs that developed within one year were excluded. Standardized incidence ratios (SIRs) of metachronous SPMs in these patients were calculated by comparing to the cancer incidence in the general population. Risk factors for SPM development, included age, sex, comorbidities and cancer-related treatments, were estimated by Cox proportional hazards models.
Results
During the 15-year study period, 870 SPMs developed among 18,026 esophageal cancer patients, with a follow-up of 27,056 person-years. The SIR for all cancers was 3.53. The SIR of follow-up period >= 10 years was 3.56; 5-10 years, 3.14; and 1-5 years, 3.06. The cancer SIRs of head and neck (15.83), stomach (3.30), lung and mediastinum (2.10), kidney (2.24) and leukemia (2.72), were significantly increased. Multivariate analysis showed that age >= 60 years (hazard ratio [HR] 0.74), being male (HR 1.46) and liver cirrhosis (HR 1.46) were independent factors. According to the treatments, major surgery (HR 1.24) increased the risk, but chemotherapy was nearly significant.
Conclusions
Patients with esophageal cancer were at increased risk of developing metachronous SPMs. The SIR remained high in follow-up > 10 years, so that close monitoring may be needed for early detection of SPM among these esophageal cancer patients.

• 出版日期2015-1-30