Secondary malignancies after rectal cancer resection with and without radiation therapy: A propensity-adjusted, population-based SEER analysis

被引：43

作者：

Warschkow, Rene ^{[1
,2
]}

Guller, Ulrich ^{[3
,4
]}

Cerny, Thomas ^{[4
]}

Schmied, Bruno Martin ^{[1
]}

Plasswilm, Ludwig ^{[5
]}

Putora, Paul Martin ^{[5
]}

机构：

[1] Cantonal Hosp, Dept Surg, St Gallen, Switzerland

[2] Heidelberg Univ, Inst Med Biometry & Informat, Heidelberg, Germany

[3] Cantonal Hosp, Dept Med Oncol & Hematol, St Gallen, Switzerland

[4] Univ Bern, Dept Visceral Surg & Med, Bern, Switzerland

[5] Cantonal Hosp, Dept Radiat Oncol, St Gallen, Switzerland

来源：

RADIOTHERAPY AND ONCOLOGY | 2017年 / 123卷 / 01期

关键词：

Rectal cancer; Radiation; Surveillance; Epidemiology and End Results (SEER) database; Propensity score; ACUTE ORGAN TOXICITY; 2ND CANCERS; ENDOMETRIAL CANCER; RADIOTHERAPY; IRRADIATION; CARCINOMA; RISK; RADIOCHEMOTHERAPY; NEOPLASMS; SURVIVAL;

D O I：

10.1016/j.radonc.2017.02.007

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: The relationship between radiation therapy for rectal cancer and secondary malignancies is debated. The present study is the first population-based analysis using conventional multivariable analyses as well as propensity score matching to assess this relationship. Methods: Overall, 77,484 patients after resection of localized or locally advanced rectal adenocarcinoma diagnosed between 1973 and 2012 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry. The occurrence of secondary malignancies diagnosed at least 1 (median follow up 5.8 years [1-39.9 years]) year after rectal cancer diagnosis was compared in patients who did and did not undergo radiation using stratified and propensity score matched Cox regression analysis. Results: Of 77,484 patients, 34,114 underwent radiation and 43,370 did not. Ignoring gender and entity, radiation therapy was not associated with secondary malignancies (hazard ratio [HR] = 0.97 (95%CI: 0.92-1.02, P = 0.269). The risk for prostate cancer was decreased and (HR = 0.42, 95%CI: 0.36-0.48, P < 0.001) and increased risk for endometrial cancer (HR = 1.95, 95%CI: 1.49-2.56, P < 0.001). Overall, patients undergoing radiation had higher risks for lung cancer (HR =1.18, 95%Cl: 1.06-1.30, P < 0.001), bladder cancer (HR = 1.54, 95%CI: 1.31-1.80, P < 0.001) and lymphomas (HR = 1.27, 95%Cl: 1.03-1.58, P = 0.026). Conclusions: The present analysis describes the occurence of secondary malignancies after pelvic radiation in patients undergoing rectal cancer surgery. Indeed, radiation for rectal cancer is associated with a significantly decreased risk of prostate cancer, however, an increased risk of endometrial, lung, and bladder cancer as well as lymphomas was observed. Overall, the risk of secondary malignancies was slightly decreased with radiation in patients undergoing rectal cancer resection, this was attributable to lower rates in prostate cancer. (C) 2017 Elsevier B.V. All rights reserved.

引用

页码：139 / 146

页数：8

共 45 条

[31] COHORT STUDY OF THE LONG-TERM EFFECT OF IRRADIATION FOR CARCINOMA OF THE UTERINE CERVIX - 2ND PRIMARY MALIGNANCIES IN THE PELVIC ORGANS IN WOMEN IRRADIATED FOR CERVICAL-CARCINOMA AT RADIUMHEMMET 1914-1965 [J].