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Co-occurrence of second primary malignancy in patients with thyroid cancer
C-H Hsu1, C-L Huang2, Y-H Hsu2
1From the Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, School of Medicine, College of Medicine, Taipei Medical University, Taipei, School of Health Care Administration, Taipei Medical University, Taipei and Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanFrom the Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, School of Medicine, College of Medicine, Taipei Medical University, Taipei, School of Health Care Administration, Taipei Medical University, Taipei and Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanFrom the Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, School of Medicine, College of Medicine, Taipei Medical University, Taipei, School of Health Care Administration, Taipei Medical University, Taipei and Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan chhsu@tmu.edu.tw.
Background:
The discovery of asynchronous or synchronous double or multiple malignancies in patients is not uncommon. The co-occurrence of second primary malignancy (SPM) could be randomly occurring or association with risk factors such as environmental, genetic predisposition and therapy-related.
Materials And Methods:
We retrieved ∼782 million claim records consisting of 10.8 million males and 10.6 million females from Taiwan's National Health Insurance, which were collected for a period of 3 years (January 2000-December 2002). All the patient records were stratified by gender and ages at a 20-year interval with SPMs and specific groups. Interestingness or Q-value was used to measure strength of the disease-disease associations.
Results:
A total of 9423 thyroid cancer (female: 7483, male: 1940), 276 184 SPM (female: 141 023, male: 135 161) and 861 co-occurrence cases (female: 583, male: 278) were recorded. The co-occurrence incidence rate of head and neck, breast, digestive system and lung was 1.93%, 1.59%, 1.44% and 1.18%, respectively. Malignancy of salivary glands, laryngx, sarcoma, lymphoid tissue, mouth, central nervous system and lungs found Q-value >10. Malignancies with intermediate Q-values (5.0-9.9) were observed in nasopharynx, kidney and ureter, breast, stomach and skin. Prostate, leukemia, urinary bladder, ovary, colon, liver and uterine cervix cancer have lower Q-values (1.0-4.9).
Conclusion:
Co-occurrence ratio of thyroid cancer and SPM was high, occurred in all organ systems. We postulated that the aggressive use of modern diagnostic modalities, aggressive radioiodine treatment, pre-existing molecular oncogen mutations, and thyroid hormone for simultaneously supple-mentary and suppressive therapies were responsible.
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