尽管第二原发癌（SPC）的负担不断增加，有关种族和民族差异的全面数据仍然缺乏。量化种族和民族在SPC患者中存活率的差异。本人口基础的回顾性队列研究利用了美国18个监测、流行病学和结果登记数据库的数据，包括2000年1月1日至2013年12月31日期间20岁及以上被诊断为最常见的SPC的人群（到2018年12月31日随访结束）。数据分析时间为2023年1月至4月。种族和民族（西班牙裔、非西班牙裔亚洲人或太平洋岛民、非西班牙裔黑人和非西班牙裔白人）。主要结果包括5年相对存活率和病因特异性存活率。计算了每个种族和民族少数群体与整体白人种族之间因癌症或心血管疾病（CVD）死亡的病因特异性危险比（HR），并根据SPC类型进行了分层分析，同时根据性别、SPC诊断年龄及年份、之前的癌症类型和分期（基线模型）进行了调整，此外还调整了县属性（家庭收入、居住地城市化程度）、SPC特征（分期、亚型）和治疗。在230,370例SPC患者（58.4%男性）中，4.5%为亚洲人或太平洋岛民，9.6%为黑人，6.4%为西班牙裔，79.5%为白人。在随访中位数54个月（IQR，12-93个月）期间，共有109,757例与癌症相关的死亡（47.6%）和18,283例与CVD相关的死亡（7.9%）发生。在基线模型中，与白人种族相比，黑人（HR，1.21；95% CI，1.18-1.23）和西班牙裔（HR，1.10；95% CI，1.07-1.13）人群的总体癌症相关死亡风险较高，而亚洲人或太平洋岛民人群较低（HR，0.93；95% CI，0.90-0.96）。在根据13种不同SPC类型进行分层分析时，黑人人群的10种SPC中，癌症相关死亡的风险较高，其中子宫癌的HR最高（HR，1.87；95% CI，1.63-2.15）；西班牙裔人群的7种SPC中，尤其是黑素瘤的风险较高（HR，1.46；95% CI，1.21-1.76）。就CVD相关死亡而言，整体HR在黑人人群中较高（HR，1.41；95% CI，1.34-1.49），11种SPC中存在风险增加，但亚洲人或太平洋岛民（HR，0.75；95% CI，0.69-0.81）和西班牙裔（HR，0.90；95% CI，0.84-0.96）人群的风险较白人种族较低。在进一步调整县属性、SPC特征和治疗后，癌症相关死亡的HR和CVD相关死亡的HR均有所降低，但方向性相同。在本SPC幸存者队列研究中，黑人人群患恶性肿瘤死亡和心血管疾病死亡的风险最高，而西班牙裔人群患癌症死亡的风险较白人人群高。在调整可能可改变因素后HR的降低表明，减少多重原发癌患者存活差异的机会存在。

Comprehensive data for racial and ethnic disparities after second primary cancers (SPCs) are lacking despite the growing burden of SPCs.To quantify racial and ethnic disparities in survival among persons with SPCs.This population-based, retrospective cohort study used data from 18 Surveillance, Epidemiology, and End Results registries in the US for persons diagnosed with the most common SPCs at age 20 years or older from January 1, 2000, to December 31, 2013 (with follow-up through December 31, 2018). Data were analyzed between January and April 2023.Race and ethnicity (Hispanic, non-Hispanic Asian or Pacific Islander, non-Hispanic Black, and non-Hispanic White).The main outcomes were 5-year relative survival and cause-specific survival. Cause-specific hazard ratios (HRs) were calculated for death from cancer or cardiovascular disease (CVD) in each racial and ethnic minority population compared with the White population overall and stratified by SPC type, with adjustment for sex, year and age at SPC diagnosis, and prior cancer type and stage (baseline model) and additionally for county attributes (household income, urbanicity), SPC characteristics (stage, subtype), and treatment.Among 230 370 persons with SPCs (58.4% male), 4.5% were Asian or Pacific Islander, 9.6% were Black, 6.4% were Hispanic, and 79.5% were White. A total of 109 757 cancer-related deaths (47.6%) and 18 283 CVD-related deaths (7.9%) occurred during a median follow-up of 54 months (IQR, 12-93 months). In baseline models, compared with the White population, the risk of cancer-related death overall was higher in the Black (HR, 1.21; 95% CI, 1.18-1.23) and Hispanic (HR, 1.10; 95% CI, 1.07-1.13) populations but lower in the Asian or Pacific Islander population (HR, 0.93; 95% CI, 0.90-0.96). When stratified by 13 SPC types, the risk of cancer-related death was higher for 10 SPCs in the Black population, with the highest HR for uterine cancer (HR, 1.87; 95% CI, 1.63-2.15), and for 7 SPCs in the Hispanic population, most notably for melanoma (HR, 1.46; 95% CI, 1.21-1.76). For CVD-related death, the overall HR was higher in the Black population (HR, 1.41; 95% CI, 1.34-1.49), with elevated risks evident for 11 SPCs, but lower in the Asian or Pacific Islander (HR, 0.75; 95% CI, 0.69-0.81) and Hispanic (HR, 0.90; 95% CI, 0.84-0.96) populations than in the White population. After further adjustments for county attributes and SPC characteristics and treatment, HRs were reduced for cancer-related death and for CVD-related death and associations in the same direction remained.In this cohort study of SPC survivors, the Black population had the highest risk of both death from cancer and death from CVD, and the Hispanic population had a higher risk of death from cancer than the White population. Attenuations in HRs after adjustment for potentially modifiable factors highlight opportunities to reduce survival disparities among persons with multiple primary cancers.