Clinical characteristics and prognostic analysis of cholangiocarcinoma-related multiple primary malignancies

doi:10.3877/cma.j.issn.2095-3232.2018.05.012

Abstract

Abstract:

Objective

To investigate the clinicopathological characteristics, location of tumors, interval time of new-onset tumor, and their relationship with the onset risk and prognosis of patients with cholangiocarcinoma-related multiple primary malignancies (CMPMs).

Methods

Clinicopathological and follow-up data of 38 550 patients diagnosed with cholangiocarcinoma from the Surveillance, Epidemiology and End Results (SEER) database of National Cancer Institute between 1973 and 2014 were collected. The standardized incidence rate (SIR) of CMPMs and the 95%CI were calculated. The incidence of different tumors, different age and different diagnostic interval time after first-onset cholangiocarcinoma were compared with SIR. The impact of different interval time of CMPMs upon the overall survival was compared.

Results

A total of 38 082 cases were diagnosed with single cholangiocarcinoma and 468 cases were diagnosed with CMPMs, with a incidence of 1.2%. The onset risk of small intestinal, pancreas, liver, and biliary tract tumors after cholangiocarcinoma was significantly higher than that in normal population (SIR=5.97, 1.58, 2.28; 95%CI: 3.09-10.44, 1.01-2.35, 1.49-3.37; P<0.05). Patients aged 30-49 and 50-59 years had a higher risk of developing other tumors, compared with the normal population (SIR=4.00, 1.67; 95%CI: 2.51-6.06, 1.25-3.19; P<0.05). At 5-10 years after surgery, the risk of other tumors in patients with cholangiocarcinoma was significantly higher than that of normal population (SIR=1.30; 95%CI: 1.08-1.55; P<0.05). The survival time of patients with cholangiocarcinoma was prolonged along with the increase of interval time of onsets of CMPMs. In particular, the overall survival of patients with CMPMs at postoperative 5 years was significantly better.

Conclusions

The diagnostic rate of CMPMs is low and the risk of missed diagnosis is high. For patients diagnosed with cholangiocarcinoma between the age of 30-59 years and have underwent surgery for over 5 years, enhance the follow-up of gastrointestinal tumors may contribute to identifying CMPMs. The survival time is prolonged along with the increase of interval time of new-onset CMPMs.

Key words: Bile duct neoplasms, Multiple primary malignancies, Prognosis

Yongfu Xiong, Gang Yang, Qiang Li, Jian Xu, Jingdong Li. Clinical characteristics and prognostic analysis of cholangiocarcinoma-related multiple primary malignancies[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(05): 396-401.

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References 21

[1]	Smith-Gagen J, Goodwin GA 3rd, Tay J. Multiple primary tumors following stage II and III rectal cancer in patients receiving radiotherapy, 1998-2010[J]. J Cancer Res Clin Oncol, 2014, 140(6): 949-955.
[2]	Han SS, Rivera GA, Tammemägi MC, et al. Risk stratification for second primary lung cancer[J]. J Clin Oncol, 2017, 35(25):2893-2899.
[3]	Chen T, Kharazmi E, Lou J, et al. Risk of second primary cancers after malignant mesothelioma and vice versa[J]. Cancer Lett, 2016, 379(1):94-99.
[4]	Chaturvedi AK, Kleinerman RA, Hildesheim A, et al. Second cancers after squamous cell carcinoma and adenocarcinoma of the cervix[J]. J Clin Oncol, 2009, 27(6):967-973.
[5]	Morton LM, Onel K, Curtis RE, et al. The rising incidence of second cancers: patterns of occurrence and identification of risk factors for children and adults[J]. Am Soc Clin Oncol Educ Book, 2014:e57-67.
[6]	赵洁敏，吴昌平．多原发癌症的研究进展[J]．癌症进展，2016，14(12):1195-1198.
[7]	朱莉菲，薛鹏，王理伟．65例多原发癌的临床回顾性研究[J]．复旦学报（医学版），2010, 37(5):591-593.
[8]	Oliveira IS, Kilcoyne A, Everett JM, et al. Cholangiocarcinoma: classification, diagnosis, staging, imaging features, and management[J]. Abdom Radiol, 2017, 42(6):1637-1649.
[9]	Banales JM, Cardinale V, Carpino G, et al. Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the European Network for the Study of Cholangiocarcinoma (ENS-CCA)[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(5):261-280.
[10]	Altekruse SF, Rosenfeld GE, Carrick DM, et al. SEER cancer registry biospecimen research: yesterday and tomorrow[J]. Cancer Epidemiol Biomarkers Prev, 2014, 23(12):2681-2687.
[11]	Hildebrand P, Humke J, Oevermann E, et al. Influence of second or multiple tumours on the prognosis of patients with colorectal cancer[J]. Acta Chir Iugosl, 2012, 59(1):31-38.
[12]	房龙．《2016年欧洲肿瘤内科学会胆管癌诊断、治疗与随访临床实践指南》摘译[J]．临床肝胆病杂志，2017, 33(2):238-243.
[13]	Ito F, Cho CS, Rikkers LF, et al. Hilar cholangiocarcinoma: current management[J]. Ann Surg, 2009, 250(2):210-218.
[14]	Keegan THM, Bleyer A, Rosenberg AS, et al. Second primary malignant neoplasms and survival in adolescent and young adult cancer survivors[J]. JAMA Oncol, 2017, 3(11):1554-1557.
[15]	孙俊杰，李双庆．多原发癌病因及发病机制的探索[J]．中国全科医学，2017, 20(9):1136-1141.
[16]	Surapaneni R, Singh P, Rajagopalan K, et al. Stage I lung cancer survivorship: risk of second malignancies and need for individualized care plan[J]. J Thorac Oncol, 2012, 7(8):1252-1256.
[17]	Ringland CL, Arkenau HT, O'connell DL, et al. Second primary colorectal cancers (SPCRCs): experiences from a large Australian Cancer Registry[J]. Ann Oncol, 2010, 21(1):92-97.
[18]	中国研究型医院学会消化道肿瘤专业委员会，中国医师协会外科医师分会多学科综合治疗专业委员会．肝脏及胆道恶性肿瘤多学科综合治疗协作组诊疗模式专家共识[J/CD]．中华普通外科学文献（电子版），2017, 11(1):1-3.
[19]	Kim JH, Lee YG, Lee J, et al. A case of combined hepatocellular-cholangiocarcinoma with sarcomatous transformation and second primary colon cancer[J]. Korean J Hepatol, 2004, 10(2):142-147.
[20]	Inaba K, Suzuki S, Sakaguchi T, et al. Double primary liver cancer (intrahepatic cholangiocarcinoma and hepatocellular carcinoma) in a patient with hepatitis C virus-related cirrhosis[J]. J Hepatobiliary Pancreat Surg, 2007, 14(2):204-209.
[21]	Long H, Wang M, Gong J, et al. Occurrence of second primary cancer after curative resection of cholangiocarcinoma: a report of5 cases[J]. Int Surg J, 2017, 4(4):1455-1457.

项目		例数	SIR	95%CI	ARE
年龄（岁）		?	?	?	?
?	0～29	0	0	0.00～60.04	-3.28
?	30～49	22	4.00^a	2.51～6.06	73.98
?	50～59	53	1.67^a	1.25～2.19	48.06
?	60～69	117	1.09	0.91～1.30	14.14
?	70～79	173	0.95	0.82～1.10	-11.00
?	80以上	103	0.82	0.68～0.98	-44.51
间隔（年）		例数	SIR	95%CI	ARE
?	1	100	0.80	0.65～0.97	-33.14
?	1～3	108	0.93	0.77～1.11	-11.46
?	3～5	83	1.2	0.94～1.50	33.42
?	5～10	109	1.30^a	1.08～1.55	53.3
?	10以上	78	1.06	0.87～1.29	12.84

项目		例数	SIR	95%CI	ARE
年龄（岁）		?	?	?	?
?	0～29	0	0	0.00～60.04	-3.28
?	30～49	22	4.00^a	2.51～6.06	73.98
?	50～59	53	1.67^a	1.25～2.19	48.06
?	60～69	117	1.09	0.91～1.30	14.14
?	70～79	173	0.95	0.82～1.10	-11.00
?	80以上	103	0.82	0.68～0.98	-44.51
间隔（年）		例数	SIR	95%CI	ARE
?	1	100	0.80	0.65～0.97	-33.14
?	1～3	108	0.93	0.77～1.11	-11.46
?	3～5	83	1.2	0.94～1.50	33.42
?	5～10	109	1.30^a	1.08～1.55	53.3
?	10以上	78	1.06	0.87～1.29	12.84

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