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Vol. 43. Issue 1.
Pages 18-25 (January - February 2019)
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Vol. 43. Issue 1.
Pages 18-25 (January - February 2019)
Original article
Incidence of second tumours in high risk prostate cancer patients according to the primary treatment applied
Incidencia de segundos tumores en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado
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J. Caño-Velasco
Corresponding author
jorcavel@gmail.com

Corresponding author.
, F. Herranz-Amo, G. Barbas-Bernardos, L. Polanco-Pujol, E. Lledó-García, C. Hernández-Fernández
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tables (6)
Table 1. Clinical variables of the series.
Table 2. Pathological variables of patients treated with radical prostatectomy.
Table 3. Comparison of clinical variables according to the primary treatment given.
Table 4. Rescue treatments, patient status at the end of study and causes of death.
Table 5. Univariate and multivariate analysis of the variables that may influence the onset of second primary tumours in the total of the series.
Table 6. Sample size, follow-up and incidence of second tumours in the literature according to primary treatment type.
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Abstract
Introduction and objectives

The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours.

Material and methods

A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n=145) or radiotherapy and androgen blockade (n=141). The homogeneity of both series was analyzed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours.

Results

The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (p=0.29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR=2.41, 95% CI: 1.31–4.34, p=0.005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors.

Conclusions

The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled.

Keywords:
Prostate cancer
Prostatectomy
External radiotherapy
Second tumour
Resumen
Introducción y objetivos

La aparición de segundos tumores primarios en pacientes con cáncer de próstata de alto riesgo debe tenerse en cuenta en la evolución natural de la enfermedad. Nuestro objetivo es evaluar la influencia del tratamiento primario con intención curativa de dichos pacientes en el desarrollo de segundos tumores primarios.

Material y métodos

Estudio retrospectivo de 286 pacientes diagnosticados entre 1996 y 2008, tratados mediante prostatectomía radical (n=145) o radioterapia y bloqueo androgénico (n=141). La homogeneidad de ambas series fue analizada con el test de la Chi-cuadrado para las variables cualitativas y la t de Student para las cuantitativas. Se realizó un análisis multivariante mediante regresión de Cox, para evaluar si el tipo de tratamiento primario influía en el desarrollo de segundos tumores.

Resultados

La mediana de edad fue de 66 años, y la mediana de seguimiento de 117,5 meses. Al final del seguimiento, 60 pacientes (21%) habían desarrollado un segundo tumor primario. En el grupo de prostatectomía se localizó en la pelvis en 13 (9%) casos y en 8 (5,7%) casos en los tratados con radioterapia y hormonoterapia (p=0,29). Las localizaciones más frecuentes por órganos fueron: colorrectal en 17 (28,3%) pacientes, pulmón en 11 (18,3%) y vejiga en 6 (10%) pacientes. En el análisis multivariable, los tratados con radioterapia y hormonoterapia duplicaban el riesgo de segundo tumor (HR=2,41, IC95%: 1,31-4,34; p=0,005) con respecto a los pacientes tratados con prostatectomía. La edad y la radioterapia de rescate no se comportaron como factores predictores independientes.

Conclusiones

La aparición de un segundo tumor primario se relacionó con el tratamiento primario administrado; así, los tratados con radioterapia y privación androgénica multiplicaron por más de 2 su riesgo.

Palabras clave:
Cáncer de próstata
Prostatectomía
Radioterapia externa
Segundo tumour

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