Secondary primary malignancy risk in patients with ovarian cancer in Taiwan: A nationwide population-based study

Yi Ping Hung, Chia Jen Liu, Yu Wen Hu, Min Huang Chen, Chun Pin Li, Chiu Mei Yeh, Tzeon Jye Chiou, Tzeng Ji Chen, Muh Hwa Yang, Yee Chao

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16 Citations (Scopus)


To evaluate the incidence of secondary primary malignancy (SPM) in patients with ovarian cancer using a nationwide retrospective population-based dataset. Patients newly diagnosed with ovarian cancer between 1997 and 2010 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated and compared with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models. Effects of surgery, chemotherapy, and radiotherapy after ovarian cancer diagnosis were regarded as time-dependent variables to prevent immortal time bias. During the 14-year study period (follow-up of 56,214 person-years), 707 cancers developed in 12,127 patients with ovarian cancer. The SIR for all cancerswas 2.78 (95% confidence interval 2.58-3.00). SIRs for followup periods of > 5, 1-5, and < 1 yearwere 1.87, 2.04, and 6.40, respectively. After the exclusion of SPM occurring within 1 year of ovarian cancer diagnosis, SIRs were significantly higher for cancers of the colon, rectum, and anus (2.14); lung and mediastinum (1.58); breast (1.68); cervix (1.65); uterus (7.96); bladder (3.17), and thyroid (2.23); as well as for leukemia (3.98) and others (3.83). Multivariate analysis showed that age ≥ 50 years was a significant SPM risk factor (hazard ratio [HR] 1.60). Different treatments for ovarian cancer, including radiotherapy (HR 2.07) and chemotherapy (HR 1.27), had different impacts on SPM risk. Patientswith ovarian cancer are at increased risk of SPMdevelopment. Age ≥ 50 years, radiotherapy, and chemotherapy are independent risk factors. Close surveillance of patients at high risk should be considered for the early detection of SPM.

Original languageEnglish
Article numbere1626
JournalMedicine (United States)
Issue number38
Publication statusPublished - Sept 2015
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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