Association of First Primary Cancer With Risk of Subsequent Primary Cancer Among Survivors of Adult-Onset Cancers in the United States（IF: JAMA, 51.273）
IMPORTANCE 重要性
The number of cancer survivors who develop new cancers is projected to increase, but comprehensive data on the risk of subsequent primary cancers (SPCs) among survivors of adult-onset cancers are limited.
据预测，罹患新癌症的癌症存活者人数将增加，但是关于成年癌症幸存者中随后发生原发癌（SPCs）风险的综合数据有限。
OBJECTIVE 目的
To quantify the overall and cancer type-specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types and sex.
通过第一原发癌症（FPC）类型和性别来量化成年发病癌症幸存者中SPC的总体风险和癌症类型特异性风险。
DESIGN, SETTING, AND PARTICIPANTS 设计、设置与参与者
A retrospective cohort study from 12 Surveillance, Epidemiology, and End Results registries in the United States, that included 1 537 101 persons aged 20 to 84 years diagnosed with FPCs from 1992-2011 (followed up until December 31, 2017) and who survived at least 5 years.
一项来自美国12个监测、流行病学和最终结果登记处的回顾性队列研究，包括从1992年至2011年（随访至2017年12月31日）被诊断为FPCs的1537101名年龄在20至84岁之间的人，他们至少存活了5年。
EXPOSURES 暴露
First primary cancer.
第一原发癌症。
MAIN OUTCOMES AND MEASURES 主要结果与措施
Incidence and mortality of SPCs per 10 000 person-years; standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with those expected in the general population.
每10000人-年SPCs的发病率和死亡率；标准化发病率（SIR）和标准化死亡率（SMR）与一般人群的预期值进行比较。
RESULTS 结果
Among 1 537 101 survivors (mean age, 60.4 years; 48.8% women), 156 442 SPC cases and 88 818 SPC deaths occurred during 11 197 890 person-years of follow-up (mean, 7.3 years). Among men, the overall risk of developing any SPCs was statistically significantly higher for 18 of the 30 FPC types, and risk of dying from any SPCs was statistically significantly higher for 27 of 30 FPC types as compared with risks in the general population. Among women, the overall risk of developing any SPCs was statistically significantly higher for 21 of the 31 FPC types, and risk of dying from any SPCs was statistically significantly higher for 28 of 31 FPC types as compared with risks in the general population. The highest overall SIR and SMR were estimated among survivors of laryngeal cancer (SIR, 1.75 [95% CI, 1.68-1.83]; incidence, 373 per 10 000 person-years) and gallbladder cancer (SMR, 3.82 [95% CI, 3.31-4.39]; mortality, 341 per 10 000 person-years) among men, and among survivors of laryngeal cancer (SIR, 2.48 [95% CI, 2.27-2.72]; incidence, 336 per 10 000 person-years; SMR, 4.56 [95% CI, 4.11-5.06]; mortality, 268 per 10 000 person-years) among women. Substantial variation existed in the associations of specific types of FPCs with specific types of SPC risk; however, only a few smoking- or obesity-associated SPCs, such as lung, urinary bladder, oral cavity/pharynx, colorectal, pancreatic, uterine corpus, and liver cancers constituted considerable proportions of the total incidence and mortality, with lung cancer alone accounting for 31% to 33%of mortality from all SPCs.
在1537101名生存者中（平均年龄60.4岁，女性占48.8%），在11197890人-年的随访中（平均7.3年），发生了156442例SPC病例和88818例SPC死亡。在男性中，发展为30种FPC中的18种的任何SPC的总体风险在统计学上均显著较高，而在30种FPC中27种的任何SPC死亡的风险在统计学上均显著高于普通人群。在女性中，在31种FPC类型中，有21种形成SPC的总体风险在统计学上显著较高；而在31种FPC类型中，有28种因任何SPC死亡的风险在统计学上显著高于普通人群。在男性喉癌幸存者中（SIR，1.75[95% CI，1.68-1.83]；发病率，373/10000人-年）和胆囊癌（SMR，3.82[95% CI，3.31-4.39]；死亡率，341/10000人-年）中，SIR和SMR最高；女性喉癌幸存者（SIR，2.48[95% CI，2.27-2.72]；发病率，336/10000人年；SMR，4.56[95% CI，4.11-5.06]；死亡率，268/10000人-年）。特定类型的FPC与特定类型的SPC风险之间的关联存在着很大的差异。但是，只有少数与吸烟或肥胖相关的SPC，例如肺、膀胱、口腔/咽部、结直肠，胰腺、子宫体和肝癌，在总发病率和死亡率中占相当大的比例，仅肺癌就占所有SPC死亡率的31%至33%。
CONCLUSIONS AND RELEVANCE 结论与意义
Among survivors of adult-onset cancers in the United States, several types of primary cancer were significantly associated with greater risk of developing and dying from an SPC, compared with the general population. Cancers associated with smoking or obesity comprised substantial proportions of overall SPC incidence and mortality among all survivors and highlight the importance of ongoing surveillance and efforts to prevent new cancers among survivors.
在美国，成年癌症的幸存者中，与普通人群相比，几种类型的原发癌与SPC发生和死亡的更大风险显著相关。在所有幸存者中，与吸烟或肥胖相关的癌症占SPC总体发病率和死亡率的很大比例，并强调了持续监测和努力预防幸存者中新癌症的重要性。
