San-Chi Chen1, Chia-Jen Liu1,2,3, Yu-Wen Hu2,3,4, Chiu-Mei Yeh5, Li-Yu Hu6, Yen-Po Wang3,7, Yi-Ping Hung1, Cheng-Hwai Tzeng1,3, Tzeon-Jye Chiou1,3,8, Tzeng-Ji Chen3,5, Chung-Jen Teng9,10,11. 1. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 2. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. 3. School of Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Department of Psychiatry, Kaohsiung Veterans General Veterans Hospital, Kaohsiung, Taiwan. 7. Endoscopy Center of Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. cjteng.tw@gmail.com. 10. School of Medicine, National Yang-Ming University, Taipei, Taiwan. cjteng.tw@gmail.com. 11. Division of Hematology and Oncology, Department of Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, 22060, New Taipei City, Taiwan. cjteng.tw@gmail.com.
Abstract
BACKGROUND: Several studies have reported an increase in second primary malignancies (SPMs) among gastric cancer patients. METHODS: Patients who were newly diagnosed with gastric cancer between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent malignancies or gastrointestinal stromal tumor were excluded. Standardized incidence ratios (SIRs) of SPMs were calculated. Risk factors for cancer development were analyzed by Cox proportional hazards models. Effects of treatments for gastric cancer were treated as time-dependent variables. RESULTS: During the 15-year study period, 47,729 gastric cancer patients were recruited. Overall, 2,110 SPMs developed during a total follow-up of 137,798 person-years. The SIR for all cancers was 1.46. The SIRs for specific follow-up periods were 1.43, 1.41, and 1.21 at >10 years, 5-10 years, and 1-5 years, respectively. After excluding SPMs that developed within 1 year, significantly higher SIRs were seen for cancers of the head and neck (1.34), esophagus (2.16), colon and rectum (1.37), bones and soft tissues (1.95), ovaries (2.89), bladder (1.47), or kidneys (1.44), as well as non-Hodgkin's lymphoma (5.56). Multivariate analysis showed that age ≥70 years [hazard ratio (HR) 1.19], being male (HR 1.37), diabetes mellitus (HR 1.30), chronic obstructive pulmonary disease (HR 1.17), and liver cirrhosis (HR 1.94) were independent risk factors. Radiotherapy (HR 1.24) and chemotherapy (HR 1.87) were independent risk factors, but surgery (HR 0.67) was not. CONCLUSIONS: Patients with gastric cancer are at increased risk of developing SPM. Close surveillance of patients with risk factors over a longer period should be considered.
BACKGROUND: Several studies have reported an increase in second primary malignancies (SPMs) among gastric cancerpatients. METHODS:Patients who were newly diagnosed with gastric cancer between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent malignancies or gastrointestinal stromal tumor were excluded. Standardized incidence ratios (SIRs) of SPMs were calculated. Risk factors for cancer development were analyzed by Cox proportional hazards models. Effects of treatments for gastric cancer were treated as time-dependent variables. RESULTS: During the 15-year study period, 47,729 gastric cancerpatients were recruited. Overall, 2,110 SPMs developed during a total follow-up of 137,798 person-years. The SIR for all cancers was 1.46. The SIRs for specific follow-up periods were 1.43, 1.41, and 1.21 at >10 years, 5-10 years, and 1-5 years, respectively. After excluding SPMs that developed within 1 year, significantly higher SIRs were seen for cancers of the head and neck (1.34), esophagus (2.16), colon and rectum (1.37), bones and soft tissues (1.95), ovaries (2.89), bladder (1.47), or kidneys (1.44), as well as non-Hodgkin's lymphoma (5.56). Multivariate analysis showed that age ≥70 years [hazard ratio (HR) 1.19], being male (HR 1.37), diabetes mellitus (HR 1.30), chronic obstructive pulmonary disease (HR 1.17), and liver cirrhosis (HR 1.94) were independent risk factors. Radiotherapy (HR 1.24) and chemotherapy (HR 1.87) were independent risk factors, but surgery (HR 0.67) was not. CONCLUSIONS:Patients with gastric cancer are at increased risk of developing SPM. Close surveillance of patients with risk factors over a longer period should be considered.
Entities:
Keywords:
Gastric cancer; Population-based study; Second primary malignancy
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