| Summary: | 碩士 === 高雄醫學大學 === 公共衛生學研究所 === 101 === Background:
The medical technique is in advance in recent years, but it does not improve the survival rate of the patients with upper aerodigestive tract cancer. The main reason is the occurrence of second primary cancer.
Purpose:
The aim of the present study was to explore the effect of substance use and alcohol metabolizing genes on the incidence and diagnostic age of second primary cancer of upper aerodigestive tract. Furthermore, we analyzed the association between second primary cancer of upper aerodigestive tract and death.
Material and methods:
This was a concurrent cohort study. 399 patients with upper aerodigestive tract cancer were recruited in Kaohsiung Medical University Chung-Ho Memorial Hospital from June, 1992 to April, 2011. When the patients were diagnosed as first primary cancer of upper aerodigestive tract, we collected their blood samples, consulted their clinical medical records, and interviewed them with questionnaire. And then the patients were followed up to ascertain the occurrence of second primary cancer of upper aerodigestive tract and the occurrence of death.
Results:
59 out of the 399 recruited patients suffered from second primary cancer of upper aerodigestive tract when the study ended. The incidence risk of metachronous second primary cancer in betel-quid lifetime exposure ≧800 quid-year chewers was 3.8 (95% C.I. of aHR: 1.1-13.3) times higher than in non-chewers. The incidence risk of second primary cancer of oral cavity in betel-quid starting age <20 years chewers, in betel-quid daily quantity ≧30 quid/day chewers, and in betel-quid lifetime exposure ≧800 quid-year chewers were respectively 5.4 (95% C.I. of aHR: 1.2-24.6), 4.4 (95% C.I. of aHR: 1.0-18.9), and 5.4 (95% C.I. of aHR: 1.3-22.7) times higher than in non-chewers. In addition, the early-onset risk of metachronous second primary cancer and second primary cancer of oral cavity were respectively 4.9 (95% C.I. of aHR: 1.3-19.4) and 10.5 times (95% C.I. of aHR: 1.0-111.9) higher in betel-quid starting age <20 years chewers than in non-chewers. The incidence risk of synchronous second primary cancer, second primary cancer of pharynx, and second primary cancer of esophagus were respectively 33.1 (95% C.I. of aHR: 2.0-536.2), 41.3 (95% C.I. of aHR: 1.8-927.2), 10.7 (95% C.I. of aHR: 1.1-100.9) times higher in alcohol drinkers with ADH1B G/G genotype and ALDH2 A/A+A/G genotype than in non-drinkers. Patients with second primary cancer of upper aerodigestive tract experienced a 4.5-fold (95% C.I. of aHR: 2.4-8.3) higher death risk than those who did not suffer from second primary cancer of upper aerodigestive tract.
Conclusions:
We found that betel-quid consumption characteristics were associated with the incidence and diagnostic age of second primary cancer of oral cavity, and that alcohol drinkers with ADH1B G/G genotype and ALDH2 A/A+A/G genotype had the higher incidence risk of second primary cancer of pharynx and esophagus. Moreover, people who were attacked by second primary cancer of upper aerodigestive tract had higher death risk than those without second primary cancer of upper aerodigestive tract.
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