title: Secondary Primary Malignancy Risk in Patients With Ovarian Cancer in Taiwan: A Nationwide Population-Based Study.
abstract: To evaluate the incidence of secondary primary malignancy (SPM) in patients with ovarian cancer using a nationwide retrospective population-based dataset. Patients newly diagnosed with ovarian cancer between 1997 and 2010 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated and compared with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models. Effects of surgery, chemotherapy, and radiotherapy after ovarian cancer diagnosis were regarded as time-dependent variables to prevent immortal time bias. During the 14-year study period (follow-up of 56,214 person-years), 707 cancers developed in 12,127 patients with ovarian cancer. The SIR for all cancers was 2.78 (95% confidence interval 2.58-3.00). SIRs for follow-up periods of >5, 1-5, and <1 year were 1.87, 2.04, and 6.40, respectively. After the exclusion of SPM occurring within 1 year of ovarian cancer diagnosis, SIRs were significantly higher for cancers of the colon, rectum, and anus (2.14); lung and mediastinum (1.58); breast (1.68); cervix (1.65); uterus (7.96); bladder (3.17), and thyroid (2.23); as well as for leukemia (3.98) and others (3.83). Multivariate analysis showed that age ≥ 50 years was a significant SPM risk factor (hazard ratio [HR] 1.60). Different treatments for ovarian cancer, including radiotherapy (HR 2.07) and chemotherapy (HR 1.27), had different impacts on SPM risk. Patients with ovarian cancer are at increased risk of SPM development. Age ≥ 50 years, radiotherapy, and chemotherapy are independent risk factors. Close surveillance of patients at high risk should be considered for the early detection of SPM.
authors.affiliation: From the Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (YPH, CJL, MHC, TJC, MHY); School of Medicine (YPH, CJL, YWH, MHC, CPL, TJC, TJC, MHY, YC); Institute of Biopharmaceutical Sciences, National Yang-Ming University (CJL); Department of Oncology (YWH, YC); Division of Gastroenterology and Hepatology, Department of Medicine (CPL, YC); Department of Family Medicine (CMY, TJC); and Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (TJC).
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Hung
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.forename: Min-Huang
authors.initials: MH
authors.lastname: Chen
authors.forename: Chun-Pin
authors.initials: CP
authors.lastname: Li
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D005472:Fluorouracil