Sun Weibo,Sun Mingxia,Li Haiting,et al.Association between postoperative radiotherapy for bladder cancer and second primary rectal cancers: a retrospective cohort study[J].Chinese Journal of Radiological Medicine and Protection,2024,44(5):367-373
Association between postoperative radiotherapy for bladder cancer and second primary rectal cancers: a retrospective cohort study
Received:July 23, 2023  
DOI:10.3760/cma.j.cn112271-20230723-00016
KeyWords:Bladder cancer  Second primary tumor  Rectal cancer  Radiotherapy
FundProject:河南省医学科技攻关计划联合共建项目(LHGJ20230060,LHGJ20210054)
Author NameAffiliationE-mail
Sun Weibo Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Sun Mingxia Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Li Haiting Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Li Ziyuan Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Tian Qin Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Ma Lijia Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China  
Yan Zechen Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China  
Ren Yilin Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China  
Liu Zhongyang Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China  
Cheng Xiaojun Department of Radiological Health, Third People's Hospital of Henan Province, Henan Institute of Occupational Medicine, Zhengzhou 450008, China  
Zhu Shaocheng Department of Radiology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, China zsc2686@163.com 
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Abstract::
      Objective To explore the association between postoperative radiotherapy for bladder cancer and the risk of second primary rectal cancer. Methods Eligible 75 120 patients with bladder cancer from the Surveillance, Epidemiology, and End Result database (SEER) of the National Cancer Institute (NCI) (1975-2017) were enrolled in this study. The second primary cancers referred to rectal cancers patients suffered after more than five years post-treatment for bladder cancer, and the cumulative incidence was estimated using Fine-Gray competing risk regression. The relative risk (RR) of rectal cancer in patients treated with or without radiotherapy (the RT group or the NRT group) was evaluated using Poisson regression. Results Among the 75 120 patients, 70 045 (92.4%) were Caucasian, with a median age of 65.8 years (54-74 years). A total of 2 236 (3%) received postoperative radiotherapy, while 72 884 (97%) received surgery alone. The 30-year follow-up revealed a cumulative incidence of rectal cancer of 0.93% in the RT group and 0.43% in the NRT group (P = 0.004). The competing risk regression analysis identified a significant association between radiotherapy and rectal cancer (HR: 1.86; 95%CI 1.26-2.74, P<0.009). Furthermore, the RR of radiotherapy-associated rectal cancer significantly increased as the diagnosis occurred earlier (1975-1985 vs. 1985-1994: RR 2.59; 95%CI 1.20-4.86, P<0.001), and a lower age at the time of radiotherapy was associated with a higher probability of second primary tumors (≤50-year old vs. > 50 year old : RR 7.89, 95%CI 2.97-21.30, P<0.001). As calculated using the Poisson distribution, the RR of second rectal tumors was higher in the RT group (RR: 2.20,95%CI 1.45-3.18, P<0.001), even after adjusting the date of diagnosis (RR: 1.77, 95%CI 1.17-2.57, P = 0.009). Conclusions An increased risk of rectal cancer following bladder cancer radiotherapy necessitates aggressive follow-ups for the purpose of early detecting second primary rectal cancer associated with bladder cancer radiotherapy.
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