title: Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study.
abstract: To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.
authors.affiliation: From the Institute of Public Health, National Yang-Ming University, Taipei (C-JT, Yi-PH); Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City (C-JT); School of Medicine, National Yang-Ming University (C-JT, Y-WH, YC, M-HY, T-JC, Yi-PH, C-JL); Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital (L-KH); School of Medicine, Fu Jen Catholic University (L-KH); Department of Oncology (Y-WH, YC); Department of Family Medicine (C-MY, T-JC); Division of Gastroenterology and Hepatology, Department of Medicine (YC); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (M-HY, Yi-PH, C-JL); and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan (C-JL).
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Teng
authors.forename: Leh-Kiong
authors.initials: LK
authors.lastname: Huon
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Hung
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D016190:Carboplatin / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000453:epidemiology*; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D013624:Taiwan / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D005472:Fluorouracil