TY - JOUR
T1 - The incidence and risk of developing a second primary esophageal cancer in patients with oral and pharyngeal carcinoma
T2 - A population-based study in Taiwan over a 25 year period
AU - Lee, Kuan Der
AU - Lu, Chang Hsien
AU - Chen, Ping Tsung
AU - Chan, Chunghuang H.
AU - Lin, Jen Tsun
AU - Huang, Cih En
AU - Chen, Chih Cheng
AU - Chen, Min Chi
N1 - Funding Information:
We thank all the staff in the Taiwan Cancer Registry and Bureau of Health Promotion, National Department of Health, Taiwan, R.O.C. This work was supported by National Science Council grants 97-2118-M-182-001, 98-2314-B-182-029-MY2 and grants CMRPD140041 from the Chang Gung Molecular Medicine Research Center, Chang Gung University, Taiwan
Funding Information:
We quantified second cancer incidences among 39,118 patients with initial diagnoses of oral and pharyngeal carcinoma, which included the primary cancer originating in the oral cavity (ICD-9:140-145 except 142), oropharynx (including the soft palate, tongue base and tonsil; ICD-9: 146, 149) and hypopharynx (including pypopharynx and pyriform sinus; ICD-9: 148), who were reported to the Taiwan Cancer Registry (TCR) http://crs.cph.ntu.edu.tw between 1 January, 1979 and 31 December, 2003. TCR was founded in 1979 and financially supported by the National Department of Health with the aim of estimating the cancer incidence in Taiwan. It is a population-based cancer registry that covered 22 million people in 2003. Hospitals with > 50 beds were obliged to submit information on newly-diagnosed cancer patients to the TCR, which reimburses the hospitals on the basis of numbers of cases reported in order to reduce the likelihood of under-reporting. All cancer registry databases in the TCR have been systemically converted to International Classification of Diseases, 9th Revision codes [20], and linked with death certificates from the National Death Database. Persons not identified by this process were therefore considered to be alive for the purpose of the current study (passive follow-up). Coding of multiple primaries followed a common set of rules proposed by the International Agency of Cancer Registries (IACR) and the International Agency for Research on Cancer (IARC) [21]. Informed consent was not required because all registry records are anonymous and open to the public.
PY - 2009/10/20
Y1 - 2009/10/20
N2 - Background: The incidence of oral and pharyngeal (including oral cavity, oropharynx and hypopharynx) carcinoma increases rapidly in Asia and South Pacific because of betel quid chewing. Thus far, large-scale epidemiological studies are not available yet to stratify these patients by their risks of developing a second primary cancer in the digestive tract including esophagus, stomach, colon, and rectum. Methods: A population-based study was conducted using the database from the Taiwan National Cancer Registry for the period 1979-2003. We quantified standardized incidence ratios (SIRs) and cumulative incidence of second primary cancers among 33,787 patients with initial diagnoses of oral and pharyngeal carcinoma. Results: Among these four digestive tract organs, the esophagus was the only site of second cancer with excess risk in patients with oral and pharyngeal carcinoma. The incidence and risk of developing a second primary esophageal cancer differed by the site of the primary index tumor, most frequently seen in hypopharyngeal cancer (71/4,218 = 1.68%, SIR = 22.76, 95% CI 17.77-28.70), followed by oropharyngeal cancer (30/3,403 = 0.88%, SIR = 14.29, 95% CI 9.64-20.39) and the least in oral cavity cancer (99/26,166 = 0.38%, SIR = 5.57, 95% CI 4.53-6.78). In addition, the risk was extraordinarily high for patients with a follow-up interval ≤ 1 year and those with first primary cancer diagnosed at age ≤50. These patients may justify more close surveillance. Conclusion: The present study represents the first population-based study in Asia attempting to stratify the patients of oral and pharyngeal carcinoma by their risk of developing a second esophageal cancer. It helps identify patients at high risk and tailor the application of intense follow-up surveillance to the estimated risk in each individual case.
AB - Background: The incidence of oral and pharyngeal (including oral cavity, oropharynx and hypopharynx) carcinoma increases rapidly in Asia and South Pacific because of betel quid chewing. Thus far, large-scale epidemiological studies are not available yet to stratify these patients by their risks of developing a second primary cancer in the digestive tract including esophagus, stomach, colon, and rectum. Methods: A population-based study was conducted using the database from the Taiwan National Cancer Registry for the period 1979-2003. We quantified standardized incidence ratios (SIRs) and cumulative incidence of second primary cancers among 33,787 patients with initial diagnoses of oral and pharyngeal carcinoma. Results: Among these four digestive tract organs, the esophagus was the only site of second cancer with excess risk in patients with oral and pharyngeal carcinoma. The incidence and risk of developing a second primary esophageal cancer differed by the site of the primary index tumor, most frequently seen in hypopharyngeal cancer (71/4,218 = 1.68%, SIR = 22.76, 95% CI 17.77-28.70), followed by oropharyngeal cancer (30/3,403 = 0.88%, SIR = 14.29, 95% CI 9.64-20.39) and the least in oral cavity cancer (99/26,166 = 0.38%, SIR = 5.57, 95% CI 4.53-6.78). In addition, the risk was extraordinarily high for patients with a follow-up interval ≤ 1 year and those with first primary cancer diagnosed at age ≤50. These patients may justify more close surveillance. Conclusion: The present study represents the first population-based study in Asia attempting to stratify the patients of oral and pharyngeal carcinoma by their risk of developing a second esophageal cancer. It helps identify patients at high risk and tailor the application of intense follow-up surveillance to the estimated risk in each individual case.
UR - http://www.scopus.com/inward/record.url?scp=70450263383&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70450263383&partnerID=8YFLogxK
U2 - 10.1186/1471-2407-9-373
DO - 10.1186/1471-2407-9-373
M3 - Article
C2 - 19843324
AN - SCOPUS:70450263383
SN - 1471-2407
VL - 9
SP - 373
JO - BMC Cancer
JF - BMC Cancer
M1 - 1471
ER -
