362 UROTHELIAL CANCER AND RISK OF SUBSEQUENT MALIGNANCIES

You have accessJournal of UrologyUrothelial Cancer: Markers + Natural History & Pathophysiology1 Apr 2011362 UROTHELIAL CANCER AND RISK OF SUBSEQUENT MALIGNANCIES Deepak Pruthi, Zoann Nugent, Alain Demers, and Piotr Czaykowski Deepak PruthiDeepak Pruthi Winnipeg, Canada More articles by this author , Zoann NugentZoann Nugent Winnipeg, Canada More articles by this author , Alain DemersAlain Demers Ottawa, Canada More articles by this author , and Piotr CzaykowskiPiotr Czaykowski Winnipeg, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.448AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urothelial cancers remain among the most frequently diagnosed cancers. Bladder cancers have been highly correlated with the diagnosis of subsequent primary malignancies. Examination of urothelial cancers should include bladder, renal pelvis, or ureter (BPRU). The purpose of this study is to examine the likelihood of developing a second primary malignancy following the diagnosis of urothelial cancer. METHODS Subjects diagnosed with urothelial cancer between April 1, 1985 and December 31, 2006 were identified from the Manitoba Cancer Registry. Data were collected on all subsequent diagnoses of a new malignancy in this cohort; subsequent urothelial cancer diagnoses were excluded. Standardized incidence ratio (SIRs) were calculated for each major cancer type, matched with the general population by age, sex, and period. Relative risks for each cancer type were calculated. Data for males were analyzed including and excluding prostate cancers. RESULTS Of 4,412 included urothelial cases, 712 patients (16.1%) subsequently developed a second primary malignancy. Overall, the risk for developing a second primary was similar between the sexes, even when prostate cancer was excluded (female SIR: 1.30, CI = 1.09–1.54; males 1.42, CI = 1.31–1.54; males excluding prostate SIR: 1.22 CI = 1.11–1.35). The risks of developing a second primary was highest within one year of diagnosis and diminished thereafter; the group at greatest risk was males aged less than 70 (SIR = 6.25; 95% Confidence Interval (CI) = 5.08–7.04). There was an increased relative risk for developing a second primary for cancers of the kidney (male), lung, breast (female), and prostate. Papillary cancers were associated with increased relative risk of developing lung, prostate, and breast (female and male). CONCLUSIONS There is an increased probability of detecting a second primary cancer (particularly in smoking-related cancers) among subjects diagnosed with urothelial cancer even when prostate cancer is excluded. Standard Incidence Ratios for selected second primaries > 31 days post bladder cancer diagnosis with comparisons to SEER dataa Site Sex Type Second Primariesb SIR (95% CI)c >70 <70 SEER data (SIR) Sweedish Study (SIR, 95% CI) Kidneyd Female Alle 2 0.90(0.11,3.26) 0.96(0.02,5.35) 0.85(0.02,4.74) 17.79gh 0.60(0.37-0.98) Papillary 2 1.18(0.14,4.27) 1.20(0.03,6.71 1.16(0.03,6.48) TCC 0 0(0,7.22) 0(0,19) 0(0,12) Male All 22 1.75(1.10,2.65) 1.90(0.95,3.40) 1.62(0.81,2.90) 11.08gh 1.38(1.02-1.79) Papillary 15 1.52(0.85,2.51) 1.50(0.60,3.08) 1.55(0.67,3.05) TCC 4 1.83(0.50,4.68) 2.21(0.27,8.00) 1.56(0.19,5.63) Lung Female All 35 2.35(1.69,3.27) 2.52(1.51,3.93) 2.18(1.24,3.53) 2.14g 3.32(2.76,3.99) Papillary 24 2.09(1.34,3.11) 1.98(1.02,3.45) 2.22(1.14,3.87) TCC 8 2.99(1.29,5.90) 3.56(0.97,9.11) 2.58(0.70,6.61) Male All 124 1.65(1.39,1.97) 1.82(1.41,2.34) 1.53(1.20,1.95) 1.54g 2.00(1.85,2.17) Papillary 93 1.59(1.30,1.95) 1.60(1.18,2.17) 1.58(1.20,2.07) TCC 27 2.03(1.34,2.96) 2.70(1.48,4.53) 1.61(0.86,2.75) CRCf Female All 16 0.92(0.52,1.49) 0.63(0.17,1.61) 1.08(0.56,1.89) Colon = 1.05; Rectum = 0.99 Colon = 1.76(1.44-2.15) Rectum = 1.67(1.25,2.24) Papillary 14 1.07(0.59,1.80) 0.79(0.22,2.03) 1.25(0.60,2.30) TCC 1 0.29(0.01,1.60) 0(0,9) 0.4(0.01,2.24) Male All 68 1.03(0.82,1.31) 0.87(0.55,1.30) 1.15(0.86,1.54) Colon=0.99; Rectum=1.01 Colon = 1.21(1.09,1.34); Rectum = 1.22(1.06,1.41) Papillary 51 0.99(0.75,1.31) 0.84(0.50,1.33) 1.10(0.76,1.55) TCC 12 1.04(0.53,1.81) 0.71(0.15,2.07) 1.23(0.56,2.33) Breast Female All 39 1.56(1.11,2.13) 1.42(0.84,2.25) 1.69(1.05,2.59) 0.95 0.98(0.85,1.13) Papillary 32 1.67(1.14,2.36) 1.58(0.90,2.56) 1.78(1.02,2.89) TCC 6 1.30(0.48,2.82) 1.07(0.13,3.85) 1.46(0.40,3.73) Male All 3 3.83(0.79,11.20) 3.33(0.08,18.55) 4.14(0.50,14.97) - 0.95(0.39,2.29) Papillary 3 4.92(1.01,14.38) 4.12(0.10,22.97) 5.44(0.66,19.67) TCC 0 0(0,21) 0(0,62) 0(0,33) Prostate Male All 224 1.83(1.60,2.08) 2.22(1.85,2.66) 1.53(1.27,1.85) 1.14g 1.41(1.34,1.49) Papillary 150 1.57(1.34,1.84) 1.76(1.40,2.20) 1.41(1.13,1.77) TCC 63 2.90(2.27,3.71) 4.16(2.90,5.79) 2.10(1.40,3.04) a This data includes the second cancers following the initial diagnosis of bladder cancer. Patients were eliminated from the calculations once they developed their second cancer. SIRs were calculated with data including prostate cancer. b Number of second primaries in the present study. c 95% CI: 95% confidence interval. Bolded text signifies statistical significance. d Excludes renal pelvis. e Includes bpru. f CRC: colorectal cancer. g P-value < 0.05. h includes kidney,renal pelvis,ureter, and other urinary organs Standardized Incidence Ratio (SIR) of second primary cancers after 31 days by histology of initial tumor, age at diagnosis, and sex Sex Type Overall Count 1985–2007 SIR (95% CI) > 70 Count < 70 SIR (95% CI) < 70 Count < 70 SIR (95% CI) Female All 131 1.30(1.09,1.54) 57 1.26(0.97,1.64) 74 1.33(1.06,1.67) Papillary 101 1.32(1.09,1.60) 44 1.22(0.91,1.64) 57 1.41(1.09,1.83) TCC 22 1.15(0.72,1.74) 9 1.32(0.60,2.50) 13 1.05(0.56,1.80) Male including Prostate All 581 1.42(1.31,1.54) 279 1.61(1.43,1.81) 302 1.28(1.14,1.43) Papillary 425 1.33(1.21,1.46) 200 1.43(1.24,1.64) 225 1.25(1.09,1.42) TCC 128 1.77(1.49,2.10) 63 2.29(1.79,2.93) 65 1.45(1.14,1.85) Male excluding Prostate All 404 1.22(1.11,1.35) 177 1.31(1.13,1.52) 227 1.16(1.02,1.32) Papillary 304 1.19(1.06,1.33) 135 1.25(1.06,1.48) 169 1.15(0.98,1.33) TCC 76 1.27(1.01,1.59) 32 1.47(1.01,2.08) 44 1.15(0.86,1.55) Bolded text indicates statistical significance © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e147-e148 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepak Pruthi Winnipeg, Canada More articles by this author Zoann Nugent Winnipeg, Canada More articles by this author Alain Demers Ottawa, Canada More articles by this author Piotr Czaykowski Winnipeg, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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