Department of Ophthalmology, VU University Medical Center, de Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
Eur J Cancer. 2010 Jul;46(11):2052-8. doi: 10.1016/j.ejca.2010.03.029. Epub 2010 Apr 17.
Retinoblastoma patients have a strongly increased risk of second malignancies, and survivors with a third or subsequent malignancy are increasingly observed. However, it has not been examined whether survivors who developed a second malignancy have a greater risk of a subsequent malignancy. On the basis of the Dutch retinoblastoma registry, the risk of a third malignancy was compared with cancer risk in the Dutch population. Cox model analysis with a time-dependent covariate was used to compare the subsequent malignancy risk and survival among patients with and without a second malignancy. Risk of a third malignancy was increased 8-fold compared with the general population. The hazard ratio (HR) of a third malignancy after a second malignancy was more than 7-fold increased compared to the risk of a second malignancy after retinoblastoma. Radiotherapy increased the risk 3-fold. A third malignancy was associated with worse survival compared with survival of patients only diagnosed with a second malignancy (HR=5.0). Survivors of retinoblastoma who already developed a second primary malignancy have an even higher risk of subsequent primary malignancies than retinoblastoma survivors without a second malignancy. Treating physicians and patients should be aware of this higher risk.
视网膜母细胞瘤患者发生第二恶性肿瘤的风险显著增加，且越来越多的患者观察到第三或后续恶性肿瘤。然而，尚未研究是否发生第二恶性肿瘤的幸存者发生后续恶性肿瘤的风险更大。基于荷兰视网膜母细胞瘤登记处，将第三恶性肿瘤的风险与荷兰人群的癌症风险进行了比较。使用时变协变量的 Cox 模型分析比较了有和无第二恶性肿瘤的患者的后续恶性肿瘤风险和生存情况。与普通人群相比，第三恶性肿瘤的风险增加了 8 倍。与视网膜母细胞瘤后发生第二恶性肿瘤的风险相比，第二恶性肿瘤后发生第三恶性肿瘤的风险比（HR）增加了 7 倍以上。放射治疗使风险增加了 3 倍。与仅诊断出第二恶性肿瘤的患者的生存相比，第三恶性肿瘤的生存更差（HR=5.0）。已经发生第二原发性恶性肿瘤的视网膜母细胞瘤幸存者发生后续原发性恶性肿瘤的风险甚至高于没有第二原发性恶性肿瘤的视网膜母细胞瘤幸存者。治疗医生和患者都应该意识到这种更高的风险。
