De Roos Anneclaire J, Deeg H Joachim, Davis Scott
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Department of Epidemiology, University of Washington, Seattle, WA 98109-1024, USA.
Cancer Causes Control. 2007 Dec;18(10):1199-208. doi: 10.1007/s10552-007-9060-2. Epub 2007 Sep 7.
Myelodysplastic syndromes (MDS) following treatment with chemotherapy or irradiation are termed 'secondary' MDS. Clinical observations suggest a worse prognosis for secondary than for primary MDS, but differences in survival have not been studied in a general population sample.
We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) program to describe survival in MDS patients according to previous cancer diagnosis. Our study included 3,938 MDS cases diagnosed in 2001-2004 and reported by registries which have participated in SEER since the 1970s.
A previous cancer diagnosis (26% of MDS cases) was associated with 13% increased risk of death from any cause among MDS cases (hazard ratio [HR]=1.13, 95% confidence interval [CI]: 1.02-1.25). Radiation treatment for a previous cancer was associated with 52% increased risk of death (95% CI: 1.15-2.02). Shortened survival was most pronounced if the latency between the previous cancer and MDS was less than five years, including lung cancer diagnosed in the year preceding MDS (HR = 3.43, 95% CI: 1.93-6.10) and lymphohematopoietic cancer 1-5 years before MDS (HR = 2.11; 95% CI: 1.33-3.36).
Our results confirm a more severe prognosis for secondary MDS than for primary MDS, associated with certain types and treatments of previous cancer.
化疗或放疗后发生的骨髓增生异常综合征（MDS）被称为“继发性”MDS。临床观察表明，继发性MDS的预后比原发性MDS更差，但尚未在一般人群样本中研究生存差异。
我们分析了监测、流行病学和最终结果（SEER）项目的数据，以根据先前的癌症诊断描述MDS患者的生存情况。我们的研究纳入了2001年至2004年诊断的3938例MDS病例，这些病例由自20世纪70年代起就参与SEER的登记处报告。
先前有癌症诊断（占MDS病例的26%）与MDS病例中任何原因导致的死亡风险增加13%相关（风险比[HR]=1.13，95%置信区间[CI]：1.02-1.25）。先前癌症的放射治疗与死亡风险增加52%相关（95%CI：1.15-2.02）。如果先前癌症与MDS之间的潜伏期小于五年，生存缩短最为明显，包括MDS前一年诊断的肺癌（HR = 3.43，95%CI：1.93-6.10）以及MDS前1至5年的淋巴造血系统癌症（HR = 2.11；95%CI：1.33-3.36）。
我们的结果证实，继发性MDS的预后比原发性MDS更严重，这与先前癌症的某些类型和治疗有关。
