Research Paper Volume 14, Issue 9 pp 3836—3855
Second primary malignancies in cervical cancer and endometrial cancer survivors: a population-based analysis
- 1 Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
- 2 Department of Health Management, Renmin Hospital of Wuhan University, Wuhan 430060, China
- 3 Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, China
Received: January 7, 2022 Accepted: April 25, 2022 Published: May 4, 2022
https://doi.org/10.18632/aging.204047How to Cite
Copyright: © 2022 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: We evaluated the relative attribution and interactions of treatment and patient-related risk factors for second primary malignancies (SPMs) in cervical and endometrial cancer survivors.
Methods: Stage I–III cervical and endometrial cancer survivors’ data from the Surveillance, Epidemiology, and End Results (SEER) registry between January 1988 and December 2015 were analyzed. The standardized incidence ratio (SIR), excess absolute risk (EAR), and corresponding 95% confidence interval (95% CI) values were calculated. Analyses were classified based on proxies of human papillomavirus (HPV), smoking, hormone, and radiotherapy (RT) status. Additive and multiplicative interactions were assessed.
Results: Cervical cancer survivors had a higher risk for developing potentially HPV and smoking-related SPMs, especially in the RT group (SIRHPV = 3.7, 95% CI: 2.9–4.6; SIRsmoking = 3.2, 95% CI: 2.8–3.6). Second vaginal cancer patients had the highest SIR (23.8, 95% CI: 14.9–36.0). There were strong synergistic interactions between RT and the proxy of smoking (Pinteraction < 0.001), accounting for 36% of potentially smoking-related SPMs in cervical cancer survivors.
Conclusions: RT, HPV, and smoking promote SPMs in cervical cancer to different extents. The SPM burden in cervical cancer survivors could be mostly attributed to smoking and RT and their interactions.
Abbreviations
AP: attribution proportion due to interaction; CI: confidence intervals; EAR: excess absolute risk; HPV: human papillomavirus; HR: hazard ratio; S: synergy index; SPMs: second primary malignancies; SEER: Surveillance, Epidemiology, and End Results; SIR: standardized incidence ratio; RERI: relative excess risk due to interaction; RT: radiotherapy.