{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:26:13Z","timestamp":1780507573613,"version":"3.54.1"},"reference-count":52,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82171890"],"award-info":[{"award-number":["82171890"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Therapeutic advances in primary gastrointestinal non\u2010Hodgkin lymphoma (PGI\u2010NHL) have improved patient prognosis but also raised concerns regarding long\u2010term health outcomes. This study assesses patterns of second primary cancers (SPCs) and cause\u2010specific mortality in PGI\u2010NHL survivors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 7556 six\u2010month survivors of PGI\u2010NHL diagnosed between 1975 and 2015 were identified from the SEER database. SPC risks were evaluated using overall and site\u2010specific standardized incidence ratios (SIRs) and absolute excess risks (AERs) relative to the US general population. Cause\u2010specific mortality was assessed through proportional death distribution, the Fine\u2013Gray competing risk regression model, standardized mortality ratios (SMRs), and AERs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 75,914 person\u2010years of follow\u2010up, 1245 patients developed 1412 SPCs (SIR\u2009=\u20091.20, 95% CI\u2009=\u20091.14\u20131.27). Significantly elevated SIRs were observed for solid tumors (SIR\u2009=\u20091.16, 95% CI\u2009=\u20091.10\u20131.23) and hematolymphoid malignancies (SIR\u2009=\u20091.82, 95% CI\u2009=\u20091.49\u20132.19). Survivors with over 20\u2009years of follow\u2010up faced increased risks of oral cavity and pharyngeal cancers (SIR\u2009=\u20092.76, 95% CI\u2009=\u20091.11\u20135.69), gastric cancer (SIR\u2009=\u20093.12, 95% CI\u2009=\u20091.15\u20136.80), pancreatic cancer (SIR\u2009=\u20092.40, 95% CI\u2009=\u20091.10\u20134.55), and leukemia (SIR\u2009=\u20092.57, 95% CI\u2009=\u20091.17\u20134.87). The risk of developing SPCs decreased with increasing age at PGI\u2010NHL diagnosis. Patients receiving combined chemoradiotherapy exhibited the highest overall SPC risk (SIR\u2009=\u20091.32, 95% CI\u2009=\u20091.09\u20131.58), particularly for gastric cancer (SIR\u2009=\u20098.20, 95% CI\u2009=\u20094.59\u201313.53) and pancreatic cancer (SIR\u2009=\u20093.15, 95% CI\u2009=\u20091.44\u20135.98). A total of 4949 deaths occurred (SMR\u2009=\u20091.80, 95% CI\u2009=\u20091.75\u20131.85), with excess mortality persisting beyond two decades. The cumulative incidence of all\u2010cause mortality was 28.9% at 5\u2009years, 45.8% at 10\u2009years, and 69.1% at 20\u2009years post\u2010diagnosis. Non\u2010cancer causes posed a significant risk, with higher mortality from infections (SMR\u2009=\u20092.48, 95% CI\u2009=\u20092.22\u20132.76), chronic liver diseases (SMR\u2009=\u20091.72, 95% CI\u2009=\u20091.20\u20132.38), and benign\/in situ neoplasms (SMR\u2009=\u20091.62, 95% CI\u2009=\u20091.05\u20132.38).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PGI\u2010NHL survivors face elevated long\u2010term SPC risk, particularly after chemoradiotherapy and in younger patients. Excess risks for both SPCs and mortality persist beyond two decades, necessitating lifelong, risk\u2010adapted survivorship care that includes cancer surveillance, infection prevention, and chronic comorbidity management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71405","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T11:45:22Z","timestamp":1763639122000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Second Cancer Incidence and Cause\u2010Specific Mortality in Primary Gastrointestinal Non\u2010Hodgkin Lymphoma Survivors: A Population\u2010Based Cohort Study"],"prefix":"10.1002","volume":"14","author":[{"given":"Jiahe","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, The First Affiliated Hospital Zhejiang University School of Medicine  Hangzhou Zhejiang People's Republic of China"},{"name":"Graduate School 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