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Increased Incidence of Second Primary Pancreatic Cancer in Patients with Prior Colorectal Cancer: A Population-Based US Study

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Abstract

Background

Identifying high-risk groups for pancreatic cancer (PC) may lead to earlier detection. We determined the risk of subsequent PC among survivors of sporadic colorectal cancer (CRC).

Methods

We evaluated data from the US Surveillance, Epidemiology, and End Results registry to identify individuals with primary CRC between the years 1973–2006. Standardized incidence ratios (SIRs) and 95 % confidence interval (95 % CI) were calculated to compare the risk of subsequent primary PC in the study cohort to that of the standard population. Analysis was stratified by age at diagnosis of CRC and sex. CRC characteristics were compared among CRC survivors with and without PC. Multivariate sub-hazard ratios were calculated to identify factors associated with subsequent primary PC, using death from non-PC causes as a competing event.

Results

Of the 273,144 patients with first primary CRC, 657 (0.24 %) developed subsequent PC. CRC survivors were more likely to develop PC (SIR 1.22; 95 % CI 1.09–1.35). Mean latency period (time between CRC and PC diagnosis) was 1, 3, and 5 years from index age of CRC 20–49, 50–64, and >65 years, respectively. Multivariate analysis showed CRC survivors >50 years had 3.5-fold, those with right-sided CRC had 1.2-fold, and those with localized and regional CRCs had sixfold and fivefold increased risk of PC, respectively.

Conclusion

This study suggests that CRC survivors have an increased risk of developing subsequent PC within 1–5 years. CRC survivors age >50 with localized/regional stage, and right-sided CRC have higher predisposition to PC.

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Abbreviations

CI:

Confidence Interval

CRC:

Colorectal cancer

FAP:

Familial adenomatous polyposis (FAP)

HNPCC:

Hereditary non-polyposis colorectal cancer

MSI:

Microsatellite instability

MSI-H:

Microsatellite instability high

NOS:

Not otherwise specified

PC:

Pancreatic cancer

SEER:

Surveillance, Epidemiology, and End Results

PJS:

Peutz–Jeghers syndrome

SHR:

Sub-hazard ratio

SIR:

Standardized incidence ratio

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Author Contributions

Erik Rahimi, MD, contributed to study concept and design, analysis and interpretation of data, and drafting of the manuscript. Sachin Batra, MD, MPH, helped in study concept and design, analysis and interpretation of data, acquisition of data, statistical analysis, and drafting of the manuscript. Nirav Thosani, MD, MHA, is acknowledged for helping in drafting of the manuscript and critically revising the manuscript for important intellectual content. Harminder Singh, MD, MPH, contributed to analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. Sushovan Guha, MD, Ph.D., helped in study concept and design, analysis and interpretation of data, drafting of the manuscript, and study supervision.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Medical School at Houston, 6431 Fannin, MSB 4.234, Houston, TX, 77030, USA

    Erik Rahimi, Sachin Batra, Nirav Thosani & Sushovan Guha

  2. Section of Gastroenterology, University of Manitoba and CancerCare Manitoba, 805-715 McDermot Avenue, Winnipeg, MB, R3E3P4, Canada

    Harminder Singh

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  1. Erik Rahimi
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Correspondence to Harminder Singh or Sushovan Guha.

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Rahimi, E., Batra, S., Thosani, N. et al. Increased Incidence of Second Primary Pancreatic Cancer in Patients with Prior Colorectal Cancer: A Population-Based US Study. Dig Dis Sci 61, 1652–1660 (2016). https://doi.org/10.1007/s10620-016-4170-x

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  • DOI: https://doi.org/10.1007/s10620-016-4170-x

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