Rate differences between first and second primary cancers may outline immune dysfunction as a key risk factor. (22nd September 2020)

• Record Type: Journal Article
• Authors: Zheng, Guoqiao; Sundquist, Kristina; Sundquist, Jan; Försti, Asta; Hemminki, Akseli; Hemminki, Kari
• Is Part Of: Cancer medicine. Volume 9:Number 21(2020)
• Page Start: 8258
• Page End: 8265
• Publication Date: 2020-09-22
• Subjects: cancer risk -- immune suppression -- multiple cancers -- risk factors; 616.994005
• DOI: 10.1002/cam4.3454
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Many cancers are increased in immunosuppressed patients and evidence is accumulating that immune dysfunction may be a contributing risk factor for second primary cancers (SPCs). The aim of this study was to explore the potential influence of immune mechanisms in SPC. Methods: We used the Swedish Cancer Registry (1990‐2015) to select 13 male and 14 female first primary cancers (FPCs) that are known to be related to immune suppression. We assessed relative risks (RRs) for any of these as concordant (same first and second cancer) and discordant FPC‐SPC pairs. Hierarchical clustering of significant RRs was performed for cancers as FPC and SPC. Results: Concordant risks for SPCs were excessive in men and women for nasal (RRs 59.3 for men and 150.6 for women), tongue/mouth (51.7 and 100.8), and lip (32.4 and 61.2) cancers. Heatmaps showed that some cancers, such as skin cancer, tongue/mouth cancers, and non‐Hodgkin lymphoma had multiple bidirectional associations as FPC and SPC. Nasal cancer and chronic lymphocytic leukemia had associations mainly as FPC while liver and kidney cancers showed most associations as SPC. Conclusions: Immune dysfunction may be a plausible contributing factor for most of the associations, which calls for experimental verification. Abstract : Relative risks for a single second primary cancer after any first primary cancer (top), and RRs for any second primary cancer after a single first primary cancer (bottom). Male data are blue and female data in yellow symbols. The vertical bars show 95%CIs. NHL, non‐Hodgkin lymphoma, CLL, chronic lymphocytic leukemia.