Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan

San Chi Chen, Chia Jen Liu, Yu Wen Hu, Chiu Mei Yeh, Li Yu Hu, Yen Po Wang, Yi Ping Hung, Cheng Hwai Tzeng, Tzeon Jye Chiou, Tzeng Ji Chen, Chung Jen Teng

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Background: Several studies have reported an increase in second primary malignancies (SPMs) among gastric cancer patients. Methods: Patients who were newly diagnosed with gastric cancer between 1997 and 2011 were recruited from the Taiwan National Health Insurance database. Those who had antecedent malignancies or gastrointestinal stromal tumor were excluded. Standardized incidence ratios (SIRs) of SPMs were calculated. Risk factors for cancer development were analyzed by Cox proportional hazards models. Effects of treatments for gastric cancer were treated as time-dependent variables. Results: During the 15-year study period, 47,729 gastric cancer patients were recruited. Overall, 2,110 SPMs developed during a total follow-up of 137,798 person-years. The SIR for all cancers was 1.46. The SIRs for specific follow-up periods were 1.43, 1.41, and 1.21 at >10 years, 5–10 years, and 1–5 years, respectively. After excluding SPMs that developed within 1 year, significantly higher SIRs were seen for cancers of the head and neck (1.34), esophagus (2.16), colon and rectum (1.37), bones and soft tissues (1.95), ovaries (2.89), bladder (1.47), or kidneys (1.44), as well as non-Hodgkin’s lymphoma (5.56). Multivariate analysis showed that age ≥70 years [hazard ratio (HR) 1.19], being male (HR 1.37), diabetes mellitus (HR 1.30), chronic obstructive pulmonary disease (HR 1.17), and liver cirrhosis (HR 1.94) were independent risk factors. Radiotherapy (HR 1.24) and chemotherapy (HR 1.87) were independent risk factors, but surgery (HR 0.67) was not. Conclusions: Patients with gastric cancer are at increased risk of developing SPM. Close surveillance of patients with risk factors over a longer period should be considered.

Original languageEnglish
Pages (from-to)490-497
Number of pages8
JournalGastric Cancer
Issue number2
Publication statusPublished - Apr 2016
Externally publishedYes


  • Gastric cancer
  • Population-based study
  • Second primary malignancy

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research


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