上泌尿道上皮癌患者之第二原發性腫瘤風險–全國性研究
郭育任1、吳冠諭1、蔡欣孜1、蔡宗欣2、蔡育賢1
成功大學附設醫院 泌尿部1；台南市立安南醫院 泌尿科2
Second Primary Malignancy Risk in Patients with Upper Urinary Tract Urothelial Carcinoma in Taiwan - A Nationwide Population-Based Study
Yuh-Ren Kuo1, Kuan-Yu Wu1, Hsin Tzu Tsai1, Tzong-Shin Tzai2, and Yuh-Shyan Tsai1
1Department of Urology, National Cheng Kung University Hospital, National Cheng Kung University; 2Department of Urology, Tainan Municipal An-Nan Hospital
Purpose: To investigate the site distribution and risk factors of second primary malignancy (SPM) in patients with upper urinary tract urothelial carcinoma (UTUC) using a nationwide population-based study.
Material and Methods: Patients, who were newly diagnosed with UTUC from 2000 to 2013, were evaluated by using Taiwan’s National Health Insurance Research Dataset. The sites and hazard ratio (HR) of SPMs were calculated. Risk factors for SPM development were analyzed by using Cox proportional hazard models.
Results: A total of 9050 patients diagnosed with UTUC were enrolled in this study. 2187 patients developed SPMs during the study period. We divided patients into 3 subgroups: primary UTUC, antecedent malignancies before UTUC, and bladder cancer history before UTUC. The risk of SPM development in antecedent malignancies group was increased by 2.5-fold compared with primary UTUC group in our cohort. The risk of SPMs in previous bladder cancer group was increased by 18% compared with primary UTUC group. The most common subsequent cancer is renal cell carcinoma (RCC) (IR: 2.11), followed by hepatocellular carcinoma (HCC) (IR 0.84). Cox proportional hazard models showed antecedent malignancies, old age (>75 years old), male sex, UTUC diagnosis after 2010, chronic kidney disease (CKD), liver disease, and higher Charlson Comorbidity Index (CCI) are the risk factors of SPM development.
Conclusion: Our results demonstrate the most common site of SPMs after UTUC are RCC and HCC in Taiwan. The most important risk factor of SPM development is antecedent malignancies before UTUC. Close surveillance is recommended for high risk patients to detect early SPMs formation.