Incidence and Mortality Rates of Second Pancreatic Cancer Among Survivors of Digestive Cancers

Abstract

Objectives We analyzed the incidence and mortality rates of second pancreatic ductal adenocarcinoma (PDAC) among survivors of digestive cancers in South Korea. Methods We evaluated data from the Korea National Health Insurance to identify individuals with digestive cancers in 2005 to 2015. The standardized incidence ratios (SIRs) of second PDACs and survival rates were evaluated. Results Among 772,534 patients with first digestive cancers, 1696 (0.22%) developed second PDACs. The incidence of second PDACs increased until 10 years since the first cancer diagnosis. Patients with biliary tract cancers (BTCs) showed a higher incidence of second PDACs than did those with gastrointestinal cancers or hepatocellular carcinoma. In ages 20 to 49 years, SIRs (95% confidence interval) were higher in survivors of hepatocellular carcinoma (3.08; 1.04–3.08), gastric cancer (3.40; 1.90–3.40), colorectal cancer (5.00; 2.75–5.00), gallbladder cancer (58.52; 11.81–58.52), intrahepatic cholangiocarcinoma (86.99; 1.73–86.99), extrahepatic cholangiocarcinoma (89.41; 27.42–89.41), and ampulla of Vater cancer (156.78; 48.08–156.78). In ages 50 to 64 years, colorectal cancer (1.42; 1.04–1.42), gastric cancer (1.66; 1.29–1.66), and BTCs revealed higher SIRs. In ages more than 65 years, SIR was increased only in BTCs. Second PDACs revealed a more favorable prognosis than first PDACs. Conclusions Careful surveillance for second PDACs after curative treatment of BTCs and colorectal cancers should be considered.

Exocrine pancreatic cancer as a second primary malignancy: A population-based study

“…In particular, first primary bile duct and gallbladder cancers were shown to carry increased risks of developing second primary EPC in both sexes (SIR [2.2−5.0]). This finding was consistent with previous reports in the Western population (SIR [2.4−13.1]), and in the Korean population using a different nationwide database (SIR [4.4−156.8]) [7,9,10,24]. In addition to shared anatomy and physiology, there may be genetic traits, lifestyle or environmental factors, and medical conditions that may have had impacts on the development of second primary EPCs as shared determinants among bile duct, gallbladder, and pancreatic cancers [24,26].…”

“…Decreased risk of second primary EPC after rectal cancer in this study (SIR [0.5−0.8]) reconfirmed the results from the literature (SIR [0.6−0.7]) [8,9,24]. However, the findings on decreased risks of second primary EPC after stomach or colon cancer in this study were contrary to those of other studies in North America, Europe [8,9,24], and Korea [7,11]. Although clarifying etiology was beyond the scope of this study, a few possible interpretations can be proposed.…”

“…Approximately 0.2% of digestive tract cancer survivors develop second primary pancreatic cancer [7,8]. Compared to the general population, the standardized incidence ratios (SIRs) of subsequent pancreatic cancers after first primary malignancies at any site ranged (0.65 to 13.14) in the SEER registries [8][9][10], and (3.08 to 156.78) in the Korean population [7,11]. Due to its dismal prognosis, the development of second primary pancreatic cancer seriously affects the prognosis of cancer survivors.…”

“…In particular, subsequent pancreatic cancer more than doubled the standardized mortality ratio of first primary cancers of the breast, small intestine, stomach, gallbladder, bile duct, and liver [10]. However, second primary pancreatic cancer has a higher resection rate and better prognosis compared to first primary pancreatic cancer, suggesting that these cancers may have been diagnosed relatively early, due to the enhanced medical surveillance of cancer survivors [7,12].…”

Development and validation of a competing risk model for second primary pancreatic ductal adenocarcinoma: A population-based study

“…A pooled analysis study of international multicenter cancer registries reported that spPDAC accounted for 6.9% of all PDAC diagnoses ( 15 ). A Korean study showed that the type of FPC can affect the probability and prognosis of spPDAC ( 16 ). In a cohort study based on 273,144 samples, an increased incidence of pancreatic cancer was found in a population of patients with previous colon cancer ( 17 ).…”