Abstract
Background: Previous studies have revealed an increased risk of second primary malignancies (SPMs) after colorectal cancer (CRC); however, no previous investigation has quantified differences in the risk of SPMs based on the histological subtypes of first primary CRC.Methods: Patients diagnosed with first primary CRC between 2000 and 2011 were identified from the Surveillance, Epidemiology, and End Results cancer registries. The patients were divided into three cohorts: classical adenocarcinoma (CA), mucinous adenocarcinoma (MA), and signet-ring cell carcinoma (SRCC). Standardized incidence ratios were calculated to assess the risk of SPMs among the patients.Results: Overall risk of SPMs was significantly higher among patients with three histological subtypes of CRC than in the general population. The risk of esophagus cancer was significantly increased in SRCC. The risk of small intestine, colon and rectum, and corpus uteri cancers was high in three histological subtypes, with the highest risk observed in SRCC, followed by MA. Increased risks of second stomach, uterus, urinary bladder, kidney, and thyroid cancers were only observed in CA patients, while increased risk of second renal pelvis cancer was limited to MA patients. Furthermore, the high overall risk of SPMs in CA patients persisted regardless of clinicopathological factors. After surgery combined with chemotherapy treatment, CA patients were more prone to developing second small intestine, colon and rectum cancers than those treated with surgery only. A lower second prostate cancer risk was observed in rectal CA patients treated with surgery combined with radiotherapy than in patients treated with surgery only.Conclusion: The present study revealed that the risk of developing SPMs after CRC varied based on the histological subtypes of the first primary CRC. Although the mechanisms underlying the observed patterns of SPM risk remain unknown, the study provided insights into future cancer surveillance based on the histological subtypes of CRC.
Highlights
Colorectal cancer (CRC) is the third most widespread cause of cancer-related deaths in both men and women in the United States, and ranks second when men and women are combined [1]
According to Survivorship Statistics released by the American Cancer Society, it was estimated that more than 1.5 million survivors in the United States were living with a previous CRC diagnosis in 2019 [2]
Patients with signet-ring cell carcinoma (SRCC) presented a higher ratio of receiving radiotherapy (16.41 vs. 14.87 vs. 21.39%, classical adenocarcinoma (CA) vs. mucinous adenocarcinoma (MA) vs. SRCC, respectively) and chemotherapy (44.74 vs. 51.07 vs. 67.81%, CA vs. MA vs. SRCC, respectively) than the other subtypes
Summary
Colorectal cancer (CRC) is the third most widespread cause of cancer-related deaths in both men and women in the United States, and ranks second when men and women are combined [1]. According to Survivorship Statistics released by the American Cancer Society, it was estimated that more than 1.5 million survivors in the United States were living with a previous CRC diagnosis in 2019 [2]. Several population-based studies have demonstrated an increased risk of developing SPMs after a previous diagnosis of CRC compared with the general population [3,4,5,6,7]. The underlying mechanisms remain unknown, the increased risk could be associated with shared genetic or environmental risk factors for different malignancies or a side effect of previous treatment for CRC. Previous studies have revealed an increased risk of second primary malignancies (SPMs) after colorectal cancer (CRC); no previous investigation has quantified differences in the risk of SPMs based on the histological subtypes of first primary CRC
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