Cimino G, Papa G, Tura S, Mazza P, Rossi Ferrini P L, Bosi A, Amadori S, Lo Coco F, D'Arcangelo E, Giannarelli D
Department of Biopathology, University La Sapienza, Rome, Italy.
J Clin Oncol. 1991 Mar;9(3):432-7. doi: 10.1200/JCO.1991.9.3.432.
The risk of second primary cancer (SPC) was evaluated in 947 patients treated for Hodgkin's disease (HD) during the period January 1969 to December 1979. The median follow-up of this series was 10.5 years (range, 9 to 19). Treatment categories included radiotherapy (RT) alone (115 patients, 12%), chemotherapy (CHT) alone (161 patients, 17%), combined RT plus CHT (381 patients, 40%), and salvage treatment for resistant or relapsing HD (290 patients, 30.6%). Fifty-six SPCs were observed, occurring between 1 and 17 years from initial treatment. Among these, secondary acute nonlymphoid leukemia (s-ANLL) was the most frequent SPC (23 cases). Secondary non-Hodgkin's lymphoma (s-NHL) occurred in 5 patients, whereas a secondary solid tumor (s-ST) was observed in 28 patients. The calculated actuarial risk (+/- SE) of developing SPC was 5.0% (+/- 0.9%) and 23.1% (+/- 5.8%) at 10 and 19 years, respectively. Concerning treatment modalities and s-ANLL risk, no cases were observed in the radiotherapy group, whereas CHT plus RT and salvage groups showed the highest actuarial risk. This was, in fact, at 10 and 19 years, 3.1% (+/- 0.9%) and 8.1% (+/- 4.0%) in the former group, and 1.8% (+/- 1.0%) and 16% (+/- 9.0%) in the latter. A statistically significant difference was observed when the CHT plus RT group was compared with CHT and RT groups (P = .04). Concerning the relationships with chemotherapeutic regimens, 12 s-ANLL cases occurred in the mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus RT group, and only one case in the group receiving doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) plus RT. A statistically significant difference of s-ANLL actuarial risk was found comparing patients receiving MOPP plus RT to all other treatment groups (P = .04). With respect to s-ST, the actuarial risk at 10 and 19 years was 2.0% (+/- 0.6%) and 13.0% (+/- 3.8%), respectively. No significant differences were found among groups treated with different modalities. These data were confirmed by a multivariate analysis, which indicated treatment modality and age as independent variables for s-ANLL and s-ST development, respectively. Based on the prolonged follow-up analysis, the actuarial SPC risk at 10 years hereby reported should reflect the real SPC incidence in our series.
对1969年1月至1979年12月期间接受霍奇金病（HD）治疗的947例患者进行了第二原发性癌症（SPC）风险评估。该系列患者的中位随访时间为10.5年（范围9至19年）。治疗类别包括单纯放疗（RT）（115例患者，12%）、单纯化疗（CHT）（161例患者，17%）、放疗联合化疗（CHT）（381例患者，40%）以及对耐药或复发HD的挽救治疗（290例患者，30.6%）。观察到56例SPC，发生在初始治疗后的1至17年。其中，继发性急性非淋巴细胞白血病（s-ANLL）是最常见的SPC（23例）。5例患者发生继发性非霍奇金淋巴瘤（s-NHL），28例患者观察到继发性实体瘤（s-ST）。计算得出发生SPC的精算风险（±SE）在10年和19年分别为5.0%（±0.9%）和23.1%（±5.8%）。关于治疗方式和s-ANLL风险，放疗组未观察到病例，而CHT联合RT组和挽救治疗组的精算风险最高。实际上，在前一组中，10年和19年时分别为3.1%（±0.9%）和8.1%（±4.0%），在后一组中为1.8%（±1.0%）和16%（±9.0%）。将CHT联合RT组与CHT组和RT组进行比较时，观察到统计学上的显著差异（P = 0.04）。关于与化疗方案的关系，氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）联合RT组发生12例s-ANLL病例，而接受多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）联合RT组仅1例。比较接受MOPP联合RT的患者与所有其他治疗组时，发现s-ANLL精算风险存在统计学上的显著差异（P = 0.04）。关于s-ST，10年和19年的精算风险分别为2.0%（±0.6%）和13.0%（±3.8%）。不同治疗方式的组间未发现显著差异。多变量分析证实了这些数据，该分析表明治疗方式和年龄分别是s-ANLL和s-ST发生的独立变量。基于延长随访分析，此处报告的10年精算SPC风险应反映我们系列中的实际SPC发病率。
