前列腺癌放疗对第二原发肺癌发生及死亡的影响

Impact of prostate cancer radiotherapy on the incidence and mortality risk of the second primary lung cancer

目的分析放射治疗与前列腺癌第二原发肺癌(SPLC)发生及死亡风险之间的关系。方法收集美国SEER数据库中2004至2014年所有前列腺癌患者的临床资料,采用竞争风险模型分析前列腺癌根治术(RP)、外放射治疗(EBRT)、粒子植入治疗(RI)和外放射治疗联合粒子植入治疗(EBRI)患者发生SPLC的累积发生率,评估SPLC的发生风险和特异性死亡风险。结果共纳入377882例前列腺癌患者,其中RP组241840例(SPLC发生4389例)、EBRT组88735例(SPLC发生2509例)、RI组30443例(SPLC发生773例)和EBRI组16874例(SPLC发生423例)。经多因素调整后的竞争风险模型分析显示,与RP组相比,接受EBRT、RI和EBRI治疗显著增加了SPLC的发生风险,部分分布风险比(sHR)及95%CI分别为1.31(1.24~1.38)、1.10(1.02~1.20)和1.12(1.01~1.24),P值均<0.05。发生SPLC的患者中,SPLC为第一死因(59.9%)。首发前列腺癌接受RI治疗与SPLC特异性死亡风险存在统计学关联(sHR=1.14,95%CI:1.03~1.26,P=0.011)。多因素调整后的竞争风险模型分析结果显示,SPLC患者年龄、种族、分期、是否接受手术和化疗均能显著影响患者生存(P值均<0.05)。结论放疗可能增加前列腺癌SPLC的发生风险,对SPLC的死亡影响仍有待于进一步研究。加强SPLC早发现、早规范化治疗有助于提高患者生存及改善预后。

Objective To investigate the associations between radiotherapy and the incidence and mortality risk of second primary lung cancer(SPLC).Methods Prostate cancer patients in the US SEER database 2004-2014 were selected.The competing risk model was used to determine the SPLC cumulative incidence rates for radical prostatectomy(RP),external beam radiotherapy(EBRT),radioactive implants(RI),and combined EBRT and RI(EBRI)groups.In addition,SPLC incidence and cancer-specific survival were evaluated.Results A total of 377882 prostate cancer patients were included in this study,of whom 241840(4389 occur SPLC)were in RP,88735(2509 occur SPLC)were in EBRT,30443(773 occur SPLC)were in RI,and 16874(423 occur SPLC)were in EBRI groups,respectively.A multivariable adjusted competing risk model analysis showed that compared with the RP group,patient treated with EBRT,RI and EBRI significantly increased the incidence risk of SPLC,with sHR(95%CI)of 1.31(1.24-1.38),1.10(1.02-1.20)and 1.12(1.01-1.24),respectively(all P<0.05).In prostate cancer patients with SPLC,SPLC was the leading cause of death(59.9%).RI treatment was associated with a higher rate of SPLC-specific death risk(sHR=1.14,95%CI:1.03-1.26,P=0.011).The multivariable adjusted competing risk model analysis showed that age,race,stage,and surgery or chemotherapy significantly affected survival of SPLC patients(all P<0.05).Conclusions Radiotherapy may increase the incidence risk of SPLC in prostate cancer patients,but its impact on death risk of SPLC remains to be further investigated.Early detection and early standardized treatment of SPLC can improve the survival and prognosis of patients.