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Incidence of subsequent cholangiocarcinomas after another malignancy: trends in a population-based study.

Mao K, Jiang W, Liu J, Wang J - Medicine (Baltimore) (2015)

Bottom Line: We found persistently elevated SIRs after colon and gallbladder cancer between ages 60 and 79 years.The SIR remained significant among gallbladder cancer survivors diagnosed after 80 years.However, radiation therapy did not contribute to increased risk.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Hepatobiliary Surgery (KM, JW), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Medicine (KM), Johns Hopkins University, Baltimore, Maryland; Department of Radiation Oncology (WJ), MD Anderson Cancer Center, Houston, Texas; Department of Breast Surgery (JL), Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Department of Surgery (JL), Johns Hopkins University, Baltimore, Maryland.

ABSTRACT
Cholangiocarcinoma (CCA) characterized by late diagnosis and poor outcomes represents the commonest malignancy of biliary tract. Understanding metachronous cancer associations may achieve earlier detection. We aimed to evaluate the risk of subsequent CCAs among common cancer survivors. The National Cancer Institute's Surveillance, Epidemiology, and End Results database (1973-2010) was reviewed for patients with 1 of the 25 primary cancers. Standardized incidence ratios (SIRs) were calculated as an approximation of relative risk for subsequent CCAs after primary malignancy. Data were stratified by age at primary cancer diagnosis, latency period, and application of radiation. A total of 1487 patients developed subsequent CCAs. For patients diagnosed with primary cancers between the ages 20 and 39 years, the risk was increased among colon (SIR 14.65), gallbladder (129.29), and uterus (7.29) cancer survivors. At ages of 40 to 59 years, oral cavity and pharynx (1.89), stomach (3.24), colon (1.76), gallbladder (11.78), and lung cancers (1.75) were associated with increased risk. We found persistently elevated SIRs after colon and gallbladder cancer between ages 60 and 79 years. The SIR remained significant among gallbladder cancer survivors diagnosed after 80 years. Gallbladder cancer showed elevated risk at all of the latency periods except first 6 to 11 months. Increased risk of lung cancer (1.66) was detected after 120 months. However, radiation therapy did not contribute to increased risk. This population-based study suggests that several initial cancers are associated with elevated risk of CCA. The increased risk may be due to shared genetic or environmental etiological factors between these malignancies. Lower threshold for CCA surveillance may be warranted in high-risk patients.

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Related in: MedlinePlus

Risk of CCA among survivors of gallbladder and colon cancers diagnosed at different age groups. The error bars indicate the 95% CIs. CCA = cholangiocarcinoma, CI = confidence interval, SIR = standardized incidence ratio.
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Figure 1: Risk of CCA among survivors of gallbladder and colon cancers diagnosed at different age groups. The error bars indicate the 95% CIs. CCA = cholangiocarcinoma, CI = confidence interval, SIR = standardized incidence ratio.

Mentions: Analysis stratified by ages at diagnosis revealed that cancers of oral cavity and pharynx, stomach, colon, gallbladder, lung, and uterus had significantly elevated SIRs for subsequent CCA (Table 1). Between the ages of 20 and 39 years, cancers of colon (14.65, 95% CI 6.32–28.86), gallbladder (129.29, 95% CI 3.27–720.34), and uterus (7.29, 95% CI 1.99–18.66) had significantly increased SIRs. Moreover, oral cavity and pharynx (1.89, 95% CI 1.14–2.95), stomach (3.24, 95% CI 1.30–6.67), colon (1.76, 95% CI 1.25–2.42), gallbladder (11.78, 95% CI 1.43–42.57), and lung cancers (1.75, 95% CI 1.02–2.80) were associated with significantly increased risk of the second CCA at the ages of 40 to 59 years. Among individuals diagnosed with an initial malignancy between the ages of 60 and 79 years, we found persistently elevated SIRs for subsequent CCA after colon cancer (1.36, 95% CI 1.14–1.60) and gallbladder cancer (8.50, 95% CI 3.42–17.52). Among patients with a primary cancer diagnosed after age 80 years, the SIR remained elevated for gallbladder cancer (13.23, 95% CI 3.6–33.87). We observed that patients with gallbladder cancer had significantly elevated risk of subsequent CCA at all of the 4 age groups, and colon cancer was associated with increased risk at the ages <80 years (except 80+ year age group). Both of gallbladder cancer and colon cancer had a prominent decrease in SIRs for second primary CCA, which revealed that age at diagnosis of the primary cancer seemed to play a role in the associations between CCA and these malignancies (Figure 1).


Incidence of subsequent cholangiocarcinomas after another malignancy: trends in a population-based study.

Mao K, Jiang W, Liu J, Wang J - Medicine (Baltimore) (2015)

Risk of CCA among survivors of gallbladder and colon cancers diagnosed at different age groups. The error bars indicate the 95% CIs. CCA = cholangiocarcinoma, CI = confidence interval, SIR = standardized incidence ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554149&req=5

Figure 1: Risk of CCA among survivors of gallbladder and colon cancers diagnosed at different age groups. The error bars indicate the 95% CIs. CCA = cholangiocarcinoma, CI = confidence interval, SIR = standardized incidence ratio.
Mentions: Analysis stratified by ages at diagnosis revealed that cancers of oral cavity and pharynx, stomach, colon, gallbladder, lung, and uterus had significantly elevated SIRs for subsequent CCA (Table 1). Between the ages of 20 and 39 years, cancers of colon (14.65, 95% CI 6.32–28.86), gallbladder (129.29, 95% CI 3.27–720.34), and uterus (7.29, 95% CI 1.99–18.66) had significantly increased SIRs. Moreover, oral cavity and pharynx (1.89, 95% CI 1.14–2.95), stomach (3.24, 95% CI 1.30–6.67), colon (1.76, 95% CI 1.25–2.42), gallbladder (11.78, 95% CI 1.43–42.57), and lung cancers (1.75, 95% CI 1.02–2.80) were associated with significantly increased risk of the second CCA at the ages of 40 to 59 years. Among individuals diagnosed with an initial malignancy between the ages of 60 and 79 years, we found persistently elevated SIRs for subsequent CCA after colon cancer (1.36, 95% CI 1.14–1.60) and gallbladder cancer (8.50, 95% CI 3.42–17.52). Among patients with a primary cancer diagnosed after age 80 years, the SIR remained elevated for gallbladder cancer (13.23, 95% CI 3.6–33.87). We observed that patients with gallbladder cancer had significantly elevated risk of subsequent CCA at all of the 4 age groups, and colon cancer was associated with increased risk at the ages <80 years (except 80+ year age group). Both of gallbladder cancer and colon cancer had a prominent decrease in SIRs for second primary CCA, which revealed that age at diagnosis of the primary cancer seemed to play a role in the associations between CCA and these malignancies (Figure 1).

Bottom Line: We found persistently elevated SIRs after colon and gallbladder cancer between ages 60 and 79 years.The SIR remained significant among gallbladder cancer survivors diagnosed after 80 years.However, radiation therapy did not contribute to increased risk.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Hepatobiliary Surgery (KM, JW), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Medicine (KM), Johns Hopkins University, Baltimore, Maryland; Department of Radiation Oncology (WJ), MD Anderson Cancer Center, Houston, Texas; Department of Breast Surgery (JL), Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Department of Surgery (JL), Johns Hopkins University, Baltimore, Maryland.

ABSTRACT
Cholangiocarcinoma (CCA) characterized by late diagnosis and poor outcomes represents the commonest malignancy of biliary tract. Understanding metachronous cancer associations may achieve earlier detection. We aimed to evaluate the risk of subsequent CCAs among common cancer survivors. The National Cancer Institute's Surveillance, Epidemiology, and End Results database (1973-2010) was reviewed for patients with 1 of the 25 primary cancers. Standardized incidence ratios (SIRs) were calculated as an approximation of relative risk for subsequent CCAs after primary malignancy. Data were stratified by age at primary cancer diagnosis, latency period, and application of radiation. A total of 1487 patients developed subsequent CCAs. For patients diagnosed with primary cancers between the ages 20 and 39 years, the risk was increased among colon (SIR 14.65), gallbladder (129.29), and uterus (7.29) cancer survivors. At ages of 40 to 59 years, oral cavity and pharynx (1.89), stomach (3.24), colon (1.76), gallbladder (11.78), and lung cancers (1.75) were associated with increased risk. We found persistently elevated SIRs after colon and gallbladder cancer between ages 60 and 79 years. The SIR remained significant among gallbladder cancer survivors diagnosed after 80 years. Gallbladder cancer showed elevated risk at all of the latency periods except first 6 to 11 months. Increased risk of lung cancer (1.66) was detected after 120 months. However, radiation therapy did not contribute to increased risk. This population-based study suggests that several initial cancers are associated with elevated risk of CCA. The increased risk may be due to shared genetic or environmental etiological factors between these malignancies. Lower threshold for CCA surveillance may be warranted in high-risk patients.

Show MeSH
Related in: MedlinePlus