霍奇金病治疗后至乳腺癌发生的时间间隔。

Wendland Merideth M M, Tsodikov Alexander, Glenn Martha J, Gaffney David K

Department of Radiation Oncology, The Huntsman Cancer Institute, Salt Lake City, Utah, USA.

Cancer. 2004 Sep 15;101(6):1275-82. doi: 10.1002/cncr.20516.

BACKGROUND

Women with Hodgkin disease (HD) who received mantle irradiation had an increased risk of developing breast carcinoma. The authors examined the influence of radiotherapy on the time interval to the development of breast carcinoma.

METHODS

Using population, cancer incidence, and survival data from the Surveillance, Epidemiology, and End Results (SEER) registries, standardized incidence ratios (SIR) were calculated and Kaplan-Meier curves were constructed to estimate breast carcinoma-free survival in women with HD treated with and without radiotherapy. The log-rank test was utilized and multivariate proportional hazard regression analysis was performed. Multivariate analysis was also performed using the PHPH regression model.

RESULTS

In 9 SEER registries, 8036 females were identified who were diagnosed with HD between 1973 and 1999. Of these women, 183 (2.3%) were subsequently diagnosed with breast carcinoma. The use of radiotherapy in the treatment of HD resulted in an increased risk of development of breast carcinoma (SIR = 1.90, P < 0.01). The log-rank test and proportional hazard regression model failed to detect a difference (P = 0.79) in breast carcinoma-free survival for women treated with and without radiotherapy. The PHPH regression model revealed that the use of radiotherapy had an adverse effect on long-term survival (relative risk [RR] = 1.84, P = 0.01), but was associated with a short-term survival advantage (RR = 0.45, P = 0.01).

CONCLUSIONS

Use of the PHPH model indicated that the use of radiotherapy in the treatment of HD resulted in an increased long-term risk for the subsequent development of breast carcinoma, but conferred a short-term reduction.

背景

接受斗篷野照射的霍奇金淋巴瘤（HD）女性患乳腺癌的风险增加。作者研究了放疗对乳腺癌发病时间间隔的影响。

方法

利用监测、流行病学和最终结果（SEER）登记处的人群、癌症发病率和生存数据，计算标准化发病率比（SIR），并构建Kaplan-Meier曲线以估计接受和未接受放疗的HD女性的无乳腺癌生存率。采用对数秩检验并进行多变量比例风险回归分析。还使用PHPH回归模型进行多变量分析。

结果

在9个SEER登记处中，确定了8036名在1973年至1999年间被诊断为HD的女性。在这些女性中，183名（2.3%）随后被诊断为乳腺癌。HD治疗中使用放疗导致患乳腺癌的风险增加（SIR = 1.90，P < 0.01）。对数秩检验和比例风险回归模型未能检测出接受和未接受放疗的女性在无乳腺癌生存率方面的差异（P = 0.79）。PHPH回归模型显示，放疗的使用对长期生存有不利影响（相对风险[RR] = 1.84，P = 0.01），但与短期生存优势相关（RR = 0.45，P = 0.01）。