接受手术的非小细胞肺癌患者发生第二原发癌的风险分析  

Risk analysis of second primary cancer occurrence in patients with non-small cell lung cancer receiving surgery

作　　者：陈莉巍 杨丽 梅同华[1] CHEN Liwei;YANG Li;MEI Tonghua(Department of Respiratory and Critical Care Medicine,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院呼吸与危重症医学科,重庆400016

出　　处：《重庆医学》2023年第22期3405-3412,共8页Chongqing medicine

基　　金：国家自然科学基金青年基金项目(82203181);国家癌症中心/国家抗肿瘤药物临床应用监测网2021年度肿瘤规范化诊疗中青年研究基金项目(DSS-YSF2022-10);重庆市科技局川渝重点研发项目(CSTB2022TIAD-CUX0001);重庆医科大学未来医学青年创新团队项目(W0102)。

摘　　要：目的评估接受手术的非小细胞肺癌(NSCLC)患者发生第二原发癌(SPC)的发病率及影响因素。方法回顾性分析监测、流行病学和最终结果(SEER)数据库中2004-2015年初始原发癌(IPC)被诊断为NSCLC并接受手术治疗患者的临床资料,计算标准化发病率(SIR)来评估SPC发生的相对风险。以死亡为竞争事件,计算累积发生率,并建立Fine-Gray次分布风险模型分析发生SPC独立影响因素。结果在符合条件的74054例患者中,12121例(16.37%)发生SPC。接受手术治疗的NSCLC患者发生SPC的SIR为2.08(95%CI:2.04~2.12,P<0.05)。其中,SPC发生在肺部和肺外的SIR分别为7.04(95%CI:6.87~7.22,P<0.05)和1.20(95%CI:1.17~1.23,P<0.05)。多因素分析显示:IPC诊断年龄、种族、婚姻、肿瘤部位、组织学类型、肿瘤直径、TNM分期、化疗史、放疗史、手术类型、淋巴结清扫史是行手术治疗的NSCLC患者发生SPC的独立影响因素(P<0.05)。结论与一般人群相比,行手术治疗的NSCLC患者发生SPC的风险很高,应针对危险因素进行早期监测。Objective To assess the incidence rate and influencing factors of second primary cancer(SPC)in the patients with non-small cell lung cancer(NSCLC)receiving surgery.Methods The clinical data of the patients with diagnosed NSCLC receiving the surgical treatment in Surveillance,Epidemiology and End Results(SEER)database during 2004-2015 was retrospectively analyzed.The standardized incidence ratio(SIR)was calculated to assess the relative risk of SPC occurrence.The cumulative incidence rate was calculated by using death as a competing event,and a Fine-Gray sub-distribution risk model was constructed to analyze the independent influencing factors of the SPC occurrence.Results Among the 74054 eligible patients,SPC occurred in 12121 cases(16.37%).SIR for the SPC occurrence in the patients with NSCLC receiving the surgery treatment was 2.08(95%CI:2.04-2.12,P<0.05).Among them,SIR of SPC occurring in the lungs and outside the lungs was 7.04(95%CI:6.87-7.22,P<0.05)and 1.20(95%CI:1.17-1.23,P<0.05),respectively.The multifactorial analysis showed that the age at diagnosis of IPC,race,marital status,tumor site,histological type,tumor diameter,TNM stage,chemotherapy history,radiotherapy history,surgical type and history of lymph node dissection were the independent influencing factors for the SPC occurrence in the patients with NSCLC undergoing surgery(P<0.05).Conclusion Compared with the general population,the patients with NSCLC receiving the surgical treatment have the high risk of SPC occurrence and the risk factors should be monitored earlier.

关 键 词：非小细胞肺癌 手术 第二原发癌 SEER数据库 标准化发病率 风险 

分 类 号：R734.2[医药卫生—肿瘤]