文章：

慢性淋巴细胞白血病患者发生第二原发恶性肿瘤的风险趋势

Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia

原文发布日期：2019-09-30

DOI: 10.1038/s41408-019-0237-1

类型: Article

开放获取: 是

英文摘要：

With improving survivorship in chronic lymphocytic leukemia (CLL), the risk of second primary malignancies (SPMs) has not been systematically addressed. Differences in risk for SPMs among CLL survivors from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) were compared to risk of individual malignancies expected in the general population. In ~270,000 person-year follow-up, 6487 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95% CI:1.17–1.23). The higher risk was for both solid (SIR 1.15; 95% CI:1.12–1.18) and hematological malignancies (SIR 1.61; 95% CI:1.5–1.73). The highest risk for SPMs was noted between 2 and 5 months after CLL diagnosis (SIR 1.57; 95% CI:1.41–1.74) and for CLL patients between 50- and 79-years-old. There was a significant increase in SPMs in years 2003–2015 (SIR 1.36; 95% CI:1.3–1.42) as compared to 1973–1982 (SIR 1.19; 95% CI:1.12–1.26). The risk of SPMs was higher in CLL patients who had received prior chemotherapy (SIR 1.38 95% CI:1.31–1.44) as compared to those untreated/treatment status unknown (SIR 1.16, 95% CI:1.13–1.19, p < 0.001). In a multivariate analysis, the hazard of developing SPMs was higher among men, post-chemotherapy, recent years of diagnosis, advanced age, and non-Whites. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL.
 

摘要翻译： 

随着慢性淋巴细胞白血病（CLL）患者生存率的提高，第二原发恶性肿瘤（SPMs）的风险尚未得到系统性评估。本研究基于监测、流行病学和最终结果（SEER）数据库（1973-2015年）的数据，比较了CLL幸存者中SPMs的风险与普通人群预期恶性肿瘤风险之间的差异。在约27万人年的随访中，共诊断出6487例新发SPMs，标准化发病比（SIR）为1.2（95%置信区间：1.17-1.23）。实体瘤（SIR 1.15；95%CI：1.12-1.18）和血液系统恶性肿瘤（SIR 1.61；95%CI：1.5-1.73）风险均显著升高。SPMs最高风险出现在CLL诊断后2至5个月内（SIR 1.57；95%CI：1.41-1.74），以及50至79岁的CLL患者中。与1973-1982年期间（SIR 1.19；95%CI：1.12-1.26）相比，2003-2015年期间SPMs显著增加（SIR 1.36；95%CI：1.3-1.42）。曾接受化疗的CLL患者发生SPMs的风险（SIR 1.38；95%CI：1.31-1.44）高于未治疗/治疗状态不明者（SIR 1.16；95%CI：1.13-1.19，p<0.001）。多变量分析显示，男性、既往化疗史、近期确诊、高龄及非白种人群发生SPMs的风险更高。实施积极的生存期管理计划并开展长期SPMs监测对改善CLL病史患者的预后至关重要。

原文链接：

Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia