The Analysis of Incidence, Risk and Survival, and the Establishment of Bivariate Model in Patients with Dual Cancers---Using Cancer Database in Taiwan

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details


The average age of the Taiwanese population is increasing, and cancer incidence increases with age. Both improved early detection of first malignancies and effective primary oncologic therapy have led to prolonged survival, and the risk of second primary malignancies (SPMs) has consequently increased. The occurrence of SPMs after primary cancer then becomes an issue of concern to clinicians and patients. Very few reports are available on the incidence and risk of second primary cancers, and most of these are single-institution reviews with relatively small case numbers and short follow-up. Our previous study using the cancer database released from the Taiwan National Cancer Registry (TNCR) showed 24% increased risk of second cancers in the patients with nasopharyngeal carcinoma (NPC) compared to the general population in Taiwan (SIR=1.24, 95% CI=1.15-1.33). The findings of what patients at higher risk for SPM and what second cancer type most common in specific primary cancer may further improve clinical management of patients presenting with dual cancers. This is because patients diagnosedwith multiple, independently derived, primary cancers versus those diagnosed with a single primary cancer with related metastatic lesions may have a different prognosis and/or response to therapy and will therefore have different treatment options. Furthermore, the bivariate failure time model can certainly provide the evaluation of association between two onset ages and possible risk factors. Specifically, two of the leading causes of cancer incidence in Taiwan, cervix cancer, column and rectum cancers, will be focused and denoted as “first primary cancers”in this study. We aim to address several issues using these population databases provided by Department of Health, Executive Yuan: (i) find the standardized incidence ratios and cumulative incidence of second cancers among individuals in whom oral, column or rectum cancers had been diagnosed as the first malignancy; (ii) establish survival model for those with and without second cancers; (iii) examine the association distribution for the two correlated onset ages of cancer; and (iv) establish a bivariate failure time model to address the effect of covariates. In summary, we aim to compare the incidence rate and survival probability of SPM in Taiwan to those in other countries and finally establish a bivariate model for onset ages of two cancers.

Project IDs

Project ID:PA9712-0639
External Project ID:NSC97-2118-M182-001
Effective start/end date01/08/0831/07/09


  • second primary malignancy (SPM)
  • cumulative incidence
  • standardizedincidence ratio
  • copula
  • bivariate failure time model


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