Second primary cancers in patients with hepatocellular carcinoma: a nationwide cohort study in Taiwan

Authors

  • Wen-Chieh Wu,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yung-Tai Chen,

    1. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
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  • Chian-Yaw Hwang,

    1. Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Department of Dermatology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chien-Wei Su,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Institute of Clinical Medicine, School of Medicine and Main Research Center, National Yang-Ming University, Taipei, Taiwan
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  • Szu-Yuan Li,

    1. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Institute of Clinical Medicine, School of Medicine and Main Research Center, National Yang-Ming University, Taipei, Taiwan
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  • Tzeng-Ji Chen,

    1. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Chia-Jen Liu,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Gastroenterology, Department of Medicine, Taoyuan branch, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Wei-Yu Kao,

    1. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Division of Gastroenterology, Department of Medicine, Taoyuan branch, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yee Chao,

    1. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Cancer center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin,

    1. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Jaw-Ching Wu

    Corresponding author
    1. Institute of Clinical Medicine, School of Medicine and Main Research Center, National Yang-Ming University, Taipei, Taiwan
    2. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Wen-Chieh Wu and Yung-Tai Chen contributed equally to this study.

Correspondence

Jaw-Ching Wu, Department of Medical Research and Education,

Taipei Veterans General Hospital, Institute of Clinical Medicine and Cancer Research Center, National Yang-Ming University, 201, Shih-Pai Road, Sec. 2,

Taipei 11217, Taiwan

Tel: +886-2-28712121, ext. 3218

Fax: 886-2-28745074

e-mail: jcwu@vghtpe.gov.tw

Abstract

Background

There has been no large-scale population-based study on the incidence and clinical manifestations of second primary cancer (SPC) after diagnosis of hepatocellular carcinoma (HCC).

Aims

This study aimed to evaluate the incidence and the risk factors of SPC following HCC diagnosis.

Method

This study used data from the National Health Insurance Research Database of Taiwan to identify all HCC patients from 1 January 1997 to 31 December 2006. Cases of SPC were gathered using the ICD9-CM codes of 140–208.91. Standardized incidence ratios (SIRs) were conducted for incidence of SPC in HCC survivors. Competing-risks regression with adjustment of death was used to analyse the risk factors of SPC.

Results

From 45 976 HCC patients, 749 (1.6%) developed SPC after 90 days of HCC diagnosis. Male HCC patients had higher risks of gastric, biliary, urinary bladder, kidney and haematological cancers compared to the general male population. Female patients had higher incidences of biliary tract, kidney and bone and soft tissue cancers. Older age and chronic kidney disease (CKD) were independent factors predicting SPC.

Conclusions

SPC in patients with HCC is not rare in Taiwan. Urinary bladder cancer and renal cancer are more specific SPC for HCC patients. Better surveillance strategies for SPC should be established for HCC survivors, especially in the elderly or those with CKD.

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