title: Secondary primary malignancy risk among patients with esophageal cancer in Taiwan: a nationwide population-based study.
abstract: 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.
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: San-Chi
authors: SC
authors: Chen
authors: Division of Hematology and Oncology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Chung-Jen
authors: CJ
authors: Teng
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Yu-Wen
authors: YW
authors: Hu
authors: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chiu-Mei
authors: CM
authors: Yeh
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Man-Hsin
authors: MH
authors: Hung
authors: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors: Li-Yu
authors: LY
authors: Hu
authors: Division of Hematology and Oncology, Department of Medicine, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan.
authors: Fan-Chen
authors: FC
authors: Ku
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Cheng-Hwai
authors: CH
authors: Tzeng
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tzeon-Jye
authors: TJ
authors: Chiou
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors: Chia-Jen
authors: CJ
authors: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
references: Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):328-34
references: 12738305
references: Int J Cancer. 2002 Jun 20;99(6):860-8
references: 12115489
references: Blood. 2003 Jul 1;102(1):43-52
references: 12623843
references: J Am Coll Surg. 2003 Dec;197(6):914-20
references: 14644278
references: J Clin Oncol. 2003 Dec 1;21(23):4336-41
references: 14645422
references: Am J Gastroenterol. 2004 Apr;99(4):582-8
references: 15089886
references: Cancer. 1985 May 1;55(9):1882-5
references: 3978572
references: Cancer. 1995 Jul 1;76(1):101-5
references: 8630859
references: Ann Thorac Surg. 1998 Jun;65(6):1529-34
references: 9647053
references: Cancer. 1953 Sep;6(5):963-8
references: 13094644
references: Int J Cancer. 2005 Jan 20;113(3):475-82
references: 15455377
references: Clin Gastroenterol Hepatol. 2005 Jan;3(1):1-10
references: 15645398
references: Int J Cancer. 2005 Mar 10;114(1):101-8
references: 15523697
references: World J Surg. 2005 Jan;29(1):46-9
references: 15592914
references: World J Gastroenterol. 2007 Mar 14;13(10):1585-94
references: 17461453
references: J Natl Cancer Inst. 2007 May 16;99(10):777-89
references: 17505073
references: Cancer Epidemiol Biomarkers Prev. 2008 Jun;17(6):1543-9
references: 18559572
references: J Gastroenterol Hepatol. 2009 May;24(5):729-35
references: 19646015
references: Cancer Causes Control. 2010 Feb;21(2):269-74
references: 19866363
references: Clin Gastroenterol Hepatol. 2011 Feb;9(2):168-74
references: 21029788
references: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references: 21296855
references: Dis Esophagus. 2012 Aug;25(6):505-11
references: 22067063
references: Int J Cancer. 2013 Jan 1;132(1):182-8
references: 22510866
references: Am J Epidemiol. 2013 Sep 1;178(5):679-90
references: 23817919
references: PLoS One. 2013;8(11):e82812
references: 24312435
references: J Am Coll Surg. 2002 May;194(5):578-83
references: 12022598
references: Health Aff (Millwood). 2003 May-Jun;22(3):61-76
references: 12757273