研究确定了可能导致继发性癌症的风险因素。

IF 503.1 1区 医学 Q1 ONCOLOGY CA: A Cancer Journal for Clinicians Pub Date : 2024-03-13 DOI:10.3322/caac.21832
Mike Fillon
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The researchers, led by Trille Kristina Kjaer, PhD, wrote that this study “aimed to investigate absolute and relative incidence of second primary cancer and examine how common etiological exposures for the first cancer were associated with development of a second cancer.”</p><p>The study included a cohort of 457,334 patients across Denmark who were diagnosed with cancer between January 1, 1997, and December 31, 2014. Each patient included in the cohort was at least 40 years old. At the time of diagnosis, their year of diagnosis, cohabitation status, income, and comorbidity were also noted, as were their genders: 50.3% (230,150) were male, and 49.7% (227,184) were female. The median age at first primary cancer was 68.3 years. Follow-up for the patients lasted up to 24 years (up to December 31, 2020).</p><p>Each patient had survived at for least 1 year after their primary cancer diagnosis had been received.</p><p>There were 27 cancer types included for both primary and secondary cancers; the relative risk of developing a new primary cancer during follow-up for the survivors was calculated with Cox proportional hazards regression.</p><p>Dr Kjaer says that it is important to note that the study was conducted in a socialized medicine society where citizens have equal access to medical treatment. As for the make-up of the cohort, she adds, “The study includes only adult cancer patients as opposed to many other studies in this field that also include childhood cancer survivors or [feature] only childhood cancer survivors. Also, we were able to take into account the competing risk of death and adjust our results for important confounders such as socioeconomic status and comorbidity.”</p><p>The researchers found that for all survivors, the incidence of a new primary cancer increased over time, from 6.3% 5 years after diagnosis to 10.5% at 10 years to 13.5% at 15 years.</p><p>Researchers found that survivors of liver, pancreatic, and lung cancer had the lowest 10-year cumulative incidence of a new primary cancer. Lung cancer was also noted to be the most frequent or second most frequent new cancer in survivors of seven of the 10 first primary cancer types associated with the highest incidence of a new cancer diagnosis at 10 years. Men had a higher cumulative incidence of new cancers than women, with the highest rates also noted in people older than 60 years. Finally, the authors observed that strong links in modifiable risk factors (i.e., smoking, alcohol intake, and diets rich in red or processed meats) were noted. Interestingly, survivors of a hormone-related cancer had a lower risk of a new hormone-related primary cancer during follow-up.</p><p>Dr Kjaer says that a novel aspect of the study is the focus on both absolute and relative measures of risk for a new primary cancer. “The use of cumulative risk models offers a more straightforward and interpretable presentation of results and will hopefully make it easier to communicate in the cancer clinics to the cancer survivors.”</p><p>Catherine M. Alfano, PhD, vice president of cancer care management and research at Northwell Health Cancer Institute in New York, New York, says that studies such as this are important because many countries—especially the United States—lack a complete registry of cancer patient data like the one used in this study for analysis. “Here in the US, we have the Surveillance, Epidemiology and End Results (SEER) registry, but it is far from a complete cohort and it likely incompletely captures subsequent cancer diagnoses in those who already carry a cancer history,” she says. “So, we have an inadequate knowledge base about the incidence and risk factors for subsequent cancers that would inform the care of these survivors.”</p><p>Dr Kjaer notes that they presented the risk of a new primary cancer by site as well as the most incidents of new cancers by site. “This makes our findings useful in the planning of surveillance programs. Along the same lines, we show that if the first cancer is associated with a risk factor, for example, smoking or alcohol consumption, that survivor has an increased risk of a new cancer that shares the same risk factors. We cannot adjust for familiar or genetic factors, treatment exposure, or risk factors on the individual level but, still, this underpins the unmet potential for both primary and perhaps also secondary prevention.”</p><p>Lidia Schapira, MD, a professor of medicine (oncology) at the Stanford University School of Medicine in Stanford, California, says that the study is important because it makes a substantial contribution to the knowledge base regarding the cumulative risk of developing a second malignancy for adult survivors of cancer. “I am familiar and always impressed by the Danish Registry and I do think it has much to offer to those of us interested in understanding health risks of cancer survivors.” Dr Schapira, who is also the director of the Cancer Survivorship Program at the Stanford Comprehensive Cancer Center, adds that she has collaborated in the past with Danish researchers on similar studies.</p><p>Dr Schapira believes that key takeaways from the study include (1) that there is a need for close monitoring for new cancers among highrisk cancer survivors and (2) that cancers related to alcohol, smoking, viruses, and diet apparently are those associated with a greater risk of a second malignancy, possibly in the same organ or in the lung. “A third point,” she adds, “is that interventions to modify these behaviors—smoking cessation is the prime example—can impact this risk and thus should be considered an important component of cancer survivorship care and visits.”</p><p>Dr Alfano says that, for her, a key message from this study relates to survivorship or follow-up care. “Follow-up care clinicians should consider the etiology of the original cancer and be aware that the same etiology, be it a risk factor like smoking or a dysregulated system like hormonally derived cancers, is likely placing that cancer survivor at increased risk for other types of cancers with that same etiology.”</p><p>Dr Kjaer believes that the results provide new possibilities and relevance for oncologists in the clinic and for cancer survivors and their families. “This knowledge about who has the greatest risk is an important indication of whom we should monitor closely. When advising cancer survivors who may be afraid of developing a second cancer, we can now provide quite precise answers regarding the risk associated with the specific type of cancer they have been treated for.”</p><p>She adds, “Second primary cancer occurs with different frequency depending on the site of the first cancer, and we find that there is a a higher cumulative incidence in cancer sites with a relatively good or good survival. 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引用次数: 0

摘要

一项利用丹麦癌症登记处数据进行的研究确定了癌症幸存者中可能有助于防止他们患上新的原发性癌症(该研究称之为继发性癌症)的风险因素。这项研究还调查了原发性癌症和继发性癌症是否有关联。这项研究由丹麦哥本哈根的丹麦癌症研究所完成,发表在《柳叶刀肿瘤学》上(doi:10.1016/S1470-2045(23)00538-7)。虽然人们对患者首次罹患癌症的风险因素,包括遗传、免疫和荷尔蒙因素以及环境和生活方式风险(包括吸烟和酗酒)的认识在不断提高,但这些问题是否也会导致不同的癌症诊断,目前还没有得到充分的研究。由Trille Kristina Kjaer博士领导的研究人员写道,这项研究 "旨在调查第二原发性癌症的绝对和相对发病率,并研究第一种癌症的常见病因暴露与第二种癌症发病的关系。"这项研究纳入了丹麦全国457334名患者的队列,这些患者在1997年1月1日至2014年12月31日期间被诊断为癌症。队列中的每位患者年龄至少为 40 岁。诊断时,他们的诊断年份、同居状况、收入、合并症以及性别也都被记录在案:50.3%(230,150 人)为男性,49.7%(227,184 人)为女性。首次罹患原发性癌症的中位年龄为 68.3 岁。Kjaer 博士说,值得注意的是,这项研究是在一个社会化医疗社会中进行的,在这个社会中,公民享有平等的医疗机会。至于队列的构成,她补充说:"这项研究只包括成年癌症患者,而这一领域的许多其他研究也包括儿童癌症幸存者,或者只[以]儿童癌症幸存者为[特征]。此外,我们还考虑到了死亡的竞争风险,并根据社会经济状况和合并症等重要的混杂因素对我们的结果进行了调整。"研究人员发现,对于所有幸存者来说,新发原发性癌症的发病率随着时间的推移而增加,从确诊后5年的6.3%增加到10年的10.5%,再增加到15年的13.5%。研究人员发现,肝癌、胰腺癌和肺癌幸存者新发原发性癌症的10年累计发病率最低。研究人员还注意到,在与 10 年后新发癌症诊断率最高的 10 种原发性癌症类型中,肺癌是幸存者最常患或第二常患的新发癌症。男性新发癌症的累积发病率高于女性,60 岁以上人群的发病率也最高。最后,作者注意到,可改变的风险因素(即吸烟、酒精摄入量和富含红肉或加工肉类的饮食)之间存在密切联系。有趣的是,激素相关癌症的幸存者在随访期间罹患新的激素相关原发性癌症的风险较低。Kjaer 博士说,这项研究的新颖之处在于同时关注了新的原发性癌症风险的绝对值和相对值。"纽约州纽约市诺斯韦尔健康癌症研究所癌症护理管理和研究副总裁凯瑟琳-阿尔法诺(Catherine M. Alfano)博士说,这样的研究非常重要,因为许多国家--尤其是美国--缺乏像本研究中用于分析的完整的癌症患者数据登记册。"她说:"在美国,我们有监测、流行病学和最终结果(SEER)登记处,但它远不是一个完整的队列,而且它可能没有完全捕捉到那些已经有癌症病史的人的后续癌症诊断。"Kjaer博士指出,他们按部位列出了新发原发性癌症的风险,并按部位列出了新发癌症的最多病例。"这使得我们的研究结果有助于监测计划的规划。同样,我们的研究结果表明,如果第一种癌症与吸烟或饮酒等危险因素有关,那么该幸存者罹患具有相同危险因素的新癌症的风险就会增加。
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Study identifies risk factors that may lead to secondary cancers

A study using data from the Danish Cancer Registry has identified risk factors among cancer survivors that might help to prevent them from developing new primary cancers, which the study calls secondary cancers. The study also has investigated whether index and second cancers might be linked. The study, from the Danish Cancer Institute in Copenhagen, Denmark, appears in Lancet Oncology (doi:10.1016/S1470-2045(23)00538-7).

Although knowledge about risk factors for the development of a patient’s first cancer, including genetic, immune, and hormonal factors as well as environmental and lifestyle risks (including smoking and alcohol use), is advancing, whether or not these issues also lead to a different cancer diagnosis is understudied. The researchers, led by Trille Kristina Kjaer, PhD, wrote that this study “aimed to investigate absolute and relative incidence of second primary cancer and examine how common etiological exposures for the first cancer were associated with development of a second cancer.”

The study included a cohort of 457,334 patients across Denmark who were diagnosed with cancer between January 1, 1997, and December 31, 2014. Each patient included in the cohort was at least 40 years old. At the time of diagnosis, their year of diagnosis, cohabitation status, income, and comorbidity were also noted, as were their genders: 50.3% (230,150) were male, and 49.7% (227,184) were female. The median age at first primary cancer was 68.3 years. Follow-up for the patients lasted up to 24 years (up to December 31, 2020).

Each patient had survived at for least 1 year after their primary cancer diagnosis had been received.

There were 27 cancer types included for both primary and secondary cancers; the relative risk of developing a new primary cancer during follow-up for the survivors was calculated with Cox proportional hazards regression.

Dr Kjaer says that it is important to note that the study was conducted in a socialized medicine society where citizens have equal access to medical treatment. As for the make-up of the cohort, she adds, “The study includes only adult cancer patients as opposed to many other studies in this field that also include childhood cancer survivors or [feature] only childhood cancer survivors. Also, we were able to take into account the competing risk of death and adjust our results for important confounders such as socioeconomic status and comorbidity.”

The researchers found that for all survivors, the incidence of a new primary cancer increased over time, from 6.3% 5 years after diagnosis to 10.5% at 10 years to 13.5% at 15 years.

Researchers found that survivors of liver, pancreatic, and lung cancer had the lowest 10-year cumulative incidence of a new primary cancer. Lung cancer was also noted to be the most frequent or second most frequent new cancer in survivors of seven of the 10 first primary cancer types associated with the highest incidence of a new cancer diagnosis at 10 years. Men had a higher cumulative incidence of new cancers than women, with the highest rates also noted in people older than 60 years. Finally, the authors observed that strong links in modifiable risk factors (i.e., smoking, alcohol intake, and diets rich in red or processed meats) were noted. Interestingly, survivors of a hormone-related cancer had a lower risk of a new hormone-related primary cancer during follow-up.

Dr Kjaer says that a novel aspect of the study is the focus on both absolute and relative measures of risk for a new primary cancer. “The use of cumulative risk models offers a more straightforward and interpretable presentation of results and will hopefully make it easier to communicate in the cancer clinics to the cancer survivors.”

Catherine M. Alfano, PhD, vice president of cancer care management and research at Northwell Health Cancer Institute in New York, New York, says that studies such as this are important because many countries—especially the United States—lack a complete registry of cancer patient data like the one used in this study for analysis. “Here in the US, we have the Surveillance, Epidemiology and End Results (SEER) registry, but it is far from a complete cohort and it likely incompletely captures subsequent cancer diagnoses in those who already carry a cancer history,” she says. “So, we have an inadequate knowledge base about the incidence and risk factors for subsequent cancers that would inform the care of these survivors.”

Dr Kjaer notes that they presented the risk of a new primary cancer by site as well as the most incidents of new cancers by site. “This makes our findings useful in the planning of surveillance programs. Along the same lines, we show that if the first cancer is associated with a risk factor, for example, smoking or alcohol consumption, that survivor has an increased risk of a new cancer that shares the same risk factors. We cannot adjust for familiar or genetic factors, treatment exposure, or risk factors on the individual level but, still, this underpins the unmet potential for both primary and perhaps also secondary prevention.”

Lidia Schapira, MD, a professor of medicine (oncology) at the Stanford University School of Medicine in Stanford, California, says that the study is important because it makes a substantial contribution to the knowledge base regarding the cumulative risk of developing a second malignancy for adult survivors of cancer. “I am familiar and always impressed by the Danish Registry and I do think it has much to offer to those of us interested in understanding health risks of cancer survivors.” Dr Schapira, who is also the director of the Cancer Survivorship Program at the Stanford Comprehensive Cancer Center, adds that she has collaborated in the past with Danish researchers on similar studies.

Dr Schapira believes that key takeaways from the study include (1) that there is a need for close monitoring for new cancers among highrisk cancer survivors and (2) that cancers related to alcohol, smoking, viruses, and diet apparently are those associated with a greater risk of a second malignancy, possibly in the same organ or in the lung. “A third point,” she adds, “is that interventions to modify these behaviors—smoking cessation is the prime example—can impact this risk and thus should be considered an important component of cancer survivorship care and visits.”

Dr Alfano says that, for her, a key message from this study relates to survivorship or follow-up care. “Follow-up care clinicians should consider the etiology of the original cancer and be aware that the same etiology, be it a risk factor like smoking or a dysregulated system like hormonally derived cancers, is likely placing that cancer survivor at increased risk for other types of cancers with that same etiology.”

Dr Kjaer believes that the results provide new possibilities and relevance for oncologists in the clinic and for cancer survivors and their families. “This knowledge about who has the greatest risk is an important indication of whom we should monitor closely. When advising cancer survivors who may be afraid of developing a second cancer, we can now provide quite precise answers regarding the risk associated with the specific type of cancer they have been treated for.”

She adds, “Second primary cancer occurs with different frequency depending on the site of the first cancer, and we find that there is a a higher cumulative incidence in cancer sites with a relatively good or good survival. To the best of our knowledge, these results are useful in the counselling of patients with cancer and the data provide new evidence for the benefits of personalized survivorship care.”

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来源期刊
CiteScore
873.20
自引率
0.10%
发文量
51
审稿时长
1 months
期刊介绍: CA: A Cancer Journal for Clinicians" has been published by the American Cancer Society since 1950, making it one of the oldest peer-reviewed journals in oncology. It maintains the highest impact factor among all ISI-ranked journals. The journal effectively reaches a broad and diverse audience of health professionals, offering a unique platform to disseminate information on cancer prevention, early detection, various treatment modalities, palliative care, advocacy matters, quality-of-life topics, and more. As the premier journal of the American Cancer Society, it publishes mission-driven content that significantly influences patient care.
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