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Annals of Oncology Advance Access originally published online on January 30, 2008
Annals of Oncology 2008 19(6):1180-1186; doi:10.1093/annonc/mdn003
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

epidemiology

The incidence and risk of second primary cancers in patients with nasopharyngeal carcinoma: a population-based study in Taiwan over a 25-year period (1979–2003)

M.-C. Chen1, I.-J. Feng2, C.-H. Lu3,4, C.-C. Chen3,4, J.-T. Lin3,4, S.-H. Huang1 and K.-D. Lee3,4,*

1 Department of Public Health and Biostatistics Consulting Center, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
2 Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
3 Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi
4 Department of Nursing, Chang Gung Institute of Technology, Chiayi, Taiwan

* Correspondence to: Dr. K.-D. Lee, Department of Hematology and Oncology, Chang Gung Memorial Hospital, 6 West Sec, Chia-Pu Road, Pu-Tz city, Chiayi 613, Taiwan. Tel: +886-5-3621000 ext 2772; Fax: +886-5-3623781; E-mail: kdlee{at}adm.cgmh.org.tw

Background: Very few reports are available on the incidence and risk of second primary cancers in nasopharyngeal carcinoma (NPC) cases, and most of these are single-institution reviews with relatively small case numbers and short follow-up.

Patients and methods: A population-based study was conducted. We quantified standardized incidence ratios (SIRs) and cumulative incidence of second cancers among 23 639 individuals with initial diagnoses of NPC.

Results: We found a 24% increased risk of second cancers in NPC patients compared with the general population [SIR = 1.24, 95% confidence interval 1.15–1.33]. Elevated SIRs were observed in the following second primary cancers: oral/pharyngeal, salivary gland, sarcoma, skin and leukemia/lymphoma. The cumulative incidence >10 years was 3.26%. The risk was higher in younger patients, especially those <40 years old. After diagnosis of second cancers, the median survival time was 1.7 years.

Conclusions: This is the largest population-based study to date from a high-incidence area. We found that NPC is associated with an increased risk of second malignancies, which had a negative impact on the survival of patients who survived NPC.

Key words: cumulative incidence, nasopharyngeal carcinoma, second primary cancer

Received for publication November 30, 2007. Revision received December 25, 2007. Accepted for publication December 31, 2007.


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