Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

doi:10.1007/s10120-015-0482-3

. 2016 Apr;19(2):490-497.

doi: 10.1007/s10120-015-0482-3. Epub 2015 Mar 13.

Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

San-Chi Chen¹, Chia-Jen Liu^{1

2

3}, Yu-Wen Hu^{2

3

4}, Chiu-Mei Yeh⁵, Li-Yu Hu⁶, Yen-Po Wang^{3

7}, Yi-Ping Hung¹, Cheng-Hwai Tzeng^{1

3}, Tzeon-Jye Chiou^{1

3

8}, Tzeng-Ji Chen^{3

5}, Chung-Jen Teng^{9

10

11}

Affiliations

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.

PMID: 25772342
DOI: 10.1007/s10120-015-0482-3

Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

San-Chi Chen et al. Gastric Cancer. 2016 Apr.

. 2016 Apr;19(2):490-497.

doi: 10.1007/s10120-015-0482-3. Epub 2015 Mar 13.

Authors

Affiliations

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.

PMID: 25772342
DOI: 10.1007/s10120-015-0482-3

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.

Keywords: Gastric cancer; Population-based study; Second primary malignancy.

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[1] J Clin Gastroenterol. 2002 May-Jun;34(5):533-5 - PubMed

[2] J Clin Gastroenterol. 2002 May-Jun;34(5):533-5 - PubMed

[3] Cancer. 1998 Apr 1;82(7):1233-7 - PubMed

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[9] Clin Gastroenterol Hepatol. 2011 Feb;9(2):168-74 - PubMed

[10] Clin Gastroenterol Hepatol. 2011 Feb;9(2):168-74 - PubMed

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Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

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Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

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