Leung W, Sandlund J T, Hudson M M, Zhou Y, Hancock M L, Zhu Y, Ribeiro R C, Rubnitz J E, Kun L E, Razzouk B, Evans W E, Pui C H
St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105-2794, USA.
Cancer. 2001 Oct 1;92(7):1959-66. doi: 10.1002/1097-0142(20011001)92:7<1959::aid-cncr1715>3.0.co;2-y.
The objective of this report was to determine the cumulative incidence of and risk factors for second malignancy and the competing risk of death due to any other cause among patients who were treated for childhood non-Hodgkin lymphoma (NHL).
The authors retrospectively reviewed a cohort of 497 patients with NHL who were treated at St. Jude Children's Research Hospital between 1970 and 1997.
A second malignancy developed in 16 patients (9 patients with solid tumors and 7 patients with secondary acute myeloid leukemia [AML]). This number was 10.8-fold (95% confidence interval, 6.1-16.9) higher than the 1.48 patients projected for the general population by SEER Cancer Statistics. The estimated cumulative incidence rate of second malignancy was 2.1% +/- 0.7% at 10 years after diagnosis of NHL and increased to 4.8% +/- 1.3% at 20 years after diagnosis. The cumulative incidence rate of second malignancy was least among patients with small noncleaved cell lymphoma (0.5% +/- 0.5% at 20 years), higher among patients with large cell lymphoma (5.8% +/- 3.3% at 20 years), and highest among patients with lymphoblastic lymphoma (10.9% +/- 3.6% at 20 years; P = 0.002 for overall comparison). Exposure to epipodophyllotoxins was a risk factor for the development of secondary AML (P < 0.001). The cumulative incidence rate of death due to other causes was significantly less for patients who were treated after June 1978 (19.9% +/- 2.2% at 10 years) compared with patients who were treated earlier (55.6% +/- 4.2% at 10 years; P < 0.001), whereas the risk of second malignancy was similar for these two eras.
Survivors of childhood NHL, especially those with lymphoblastic histology, are at a greater risk of developing a second malignancy compared with the general population. The incidence rate of second malignancy has remained unchanged despite a recent decline in the risk of death related to primary NHL or earlier treatment complications.
本报告的目的是确定儿童非霍奇金淋巴瘤（NHL）患者发生第二原发恶性肿瘤的累积发病率和危险因素，以及因任何其他原因导致死亡的竞争风险。
作者回顾性分析了1970年至1997年间在圣裘德儿童研究医院接受治疗的497例NHL患者队列。
16例患者发生了第二原发恶性肿瘤（9例为实体瘤，7例为继发性急性髓系白血病[AML]）。这一数字比监测、流行病学与最终结果（SEER）癌症统计数据预测的一般人群中的1.48例高出10.8倍（95%置信区间，6.1 - 16.9）。NHL诊断后10年时，第二原发恶性肿瘤的估计累积发病率为2.1%±0.7%，诊断后20年时增至4.8%±1.3%。在小无裂细胞淋巴瘤患者中，第二原发恶性肿瘤的累积发病率最低（20年时为0.5%±0.5%），在大细胞淋巴瘤患者中较高（20年时为5.8%±3.3%），在淋巴母细胞淋巴瘤患者中最高（20年时为10.9%±3.6%；总体比较P = 0.002）。接触表鬼臼毒素是继发性AML发生的危险因素（P < 0.001）。与早期接受治疗的患者（10年时为55.6%±4.2%）相比，1978年6月以后接受治疗的患者因其他原因导致死亡的累积发病率显著更低（10年时为19.9%±2.2%；P < 0.001），而这两个时期第二原发恶性肿瘤的风险相似。
与一般人群相比，儿童NHL幸存者，尤其是具有淋巴母细胞组织学特征的幸存者，发生第二原发恶性肿瘤的风险更高。尽管与原发性NHL或早期治疗并发症相关的死亡风险最近有所下降，但第二原发恶性肿瘤的发病率仍未改变。
