CRC: location affects risk for second primary gastrointestinal cancer

  • Broman KK & al.
  • Ann Surg Oncol
  • 4 Apr 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Colorectal cancer (CRC) location is tied to risk for second primary gastrointestinal (GI) malignancies in specific locations.

Why this matters

  • CRC history is already a known risk factor for second primary GI cancer, but location-specific risks are not as clear.

Key results

  • 30.3% had right-sided, 35.3% left-, 34.3% rectal first primary CRC (all higher than average).
  • 4.3% developed second primary GI cancer (64% CRC; 36% not).
  • Primary at any location was tied to:
    • increased risk for small intestine cancer (standardized incidence ratio [SIR], 2.95 [95% CI, 2.82-3.08]), 
    • bile duct cancer (1.29 [1.22-1.36]), and
    • other CRCs (multiple locations); but
    • decreased liver (0.78 [0.74-0.82]), gallbladder (0.65 [0.59-0.72]) cancer risk.
  • Right-sided primary CRC was tied to increased small intestine (SIR, 4.06 [95% CI, 3.78-4.36), pancreatic (1.14 [1.09-1.19]) malignancy risk vs left/rectal initial locations.
  • Left-sided was linked to increased esophageal cancer risk (SIR, 1.16 [95% CI, 1.08-1.24]).
  • Pancreatic cancer risk was decreased with left-sided/rectal primary initial location.

Study design

  • Retrospective study; 281,413 patients with CRC (42% localized).
  • Median follow-up, 4.9 years.
  • Funding: None disclosed.

Limitations

  • Retrospective; some medical record misclassification should be assumed.
  • Information on crucial risk factors (e.g., family history, IBD) unavailable.
  • Follow-up possibly too short to capture some cases.

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