非转移性前列腺癌根治术后发生第二原发癌的危险因素分析

Analysis of risk factors for second primary malignancies after radical prostatectomy for non-metastatic prostate cancer

目的探索非转移性前列腺癌根治术后发生第二原发癌(secondary primary malignancies,SPM)的危险因素。方法从监测、流行病学和最终结果(Surveillance,Epidemiology,and End Results,SEER)数据库筛选2010年-2015年诊断为T1-4N0M0的前列腺癌患者的临床资料。根据治疗方式分为单纯手术组、手术加放射治疗(以下简称放疗)组和手术加化学药物治疗(以下简称化疗)组,比较不同治疗方式下SPM的发生率及常见部位。结果本研究共纳入患者243094例,发生SPM者19344例(8.0%),发生SPM的中位时间为36个月。发生SPM最常见的前五个部位分别为肺和支气管、膀胱、皮肤、肾和肾盂、结直肠。Logistic回归分析显示,种族、年龄、化疗、放疗为SPM的独立影响因素。手术加化疗组SPM发生率(19.7%)显著高于单纯手术组(6.4%)和手术加放疗组(8.3%),差异有统计学意义,但3组SPM累及的系统差异无统计学意义,前四位均为消化系统、泌尿系统、免疫系统和呼吸系统。结论前列腺癌患者行手术加放疗和化疗的情况下,SPM发生率增加,尤其是手术加化疗组;不同治疗方案中SPM主要发生部位类似,放疗患者的SPM更容易出现在消化系统。对前列腺癌患者采用不同治疗方式后,除了警惕前列腺癌复发和转移外,还应关注SPM的发生。

Objective To investigate the risk factors for secondary primary malignancies(SPM)after radical prostatectomy of non-metastatic prostate cancer.Methods The clinical data of patients diagnosed with T1-4N0M0 prostate cancer from 2010 to 2015 were screened from the Surveillance,Epidemiology,and End Results(SEER)database.Patients were divided into operation group,operation plus radiotherapy group,and operation plus chemotherapy group according to the treatment methods.The incidence and common sites of SPM under different treatment methods were compared.Results A total of 243094 patients were included in this study,and 19344 patients(8.0%)developed SPM.The median time for SPM was 36 months.The top five most common organs of SPM were lungs and bronchus,bladder,skin,kidney and renal pelvis,and colorectal.Logistic regression analysis showed that race,age,chemotherapy and radiotherapy were independent factors influencing SPM.The incidence of SPM in the surgery plus chemotherapy group(19.7%)was significantly higher than that in operation group(6.4%)and operation plus radiotherapy group(8.3%)(P<0.05),but no significant difference of SPM involved system among three group.The mainly four involved systems were digestive system,urinary system,immune system and respiratory system.Conclusion The incidence of SPM is increased in patients receiving surgery plus radiotherapy or surgery plus chemotherapy,especially in the latter group.The SPM distributed at similar sites,but more likely occurred in the digestive system in patients receiving surgery plus radiotherapy.For prostate cancer patients with different treatment methods,attention should be paid to the occurrence of SPM in addition to the vigilance of recurrence and metastasis of prostate cancer.