Department of Radiation Oncology, Brigham & Women's Hospital, Dana-Farber Cancer Institute, and the Children's Hospital, Boston, Massachusetts.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):636-41. doi: 10.1016/j.ijrobp.2013.11.237.
To quantify the incidence of thyroid cancer after Hodgkin lymphoma (HL) and determine disease characteristics, risk factors, and treatment outcomes.
Thyroid cancer cases were retrospectively identified from a multi-institutional database of 1981 HL patients treated between 1969 and 2008. Thyroid cancer risk factors were evaluated by a Poisson regression model.
With a median follow-up duration of 14.3 years (range, 0-41.2 years), 28 patients (1.4%) developed a thyroid malignancy. The overall incidence rate (expressed as the number of cases per 10,000 person-years) and 10-year cumulative incidence of thyroid cancer were 9.6 and 0.26%, respectively. There were no observed cases of thyroid malignancy in patients who received neck irradiation for HL after age 35 years. Age <20 years at HL diagnosis and female sex were significantly associated with thyroid cancer. The incidence rates of females aged <20 at HL diagnosis in the first 10 years, ≥10 years, ≥15 years, and ≥20 years after treatment were 5, 31, 61, and 75 cases per 10,000 person-years of follow-up, respectively. At a median follow-up of 3.5 years after the thyroid cancer diagnosis, 26 patients (93%) were alive without disease, 1 (4%) was alive with metastatic disease, and 1 (4%) died of metastatic disease, at 6 and 3.6 years after the thyroid cancer diagnosis, respectively.
Although HL survivors have an increased risk for thyroid cancer, the overall incidence is low. Routine thyroid cancer screening may benefit females treated at a young age and ≥10 years from HL treatment owing to their higher risk, which increases over time.
定量分析霍奇金淋巴瘤（HL）后甲状腺癌的发病率，并确定疾病特征、风险因素和治疗结果。
从 1969 年至 2008 年间治疗的 1981 例 HL 患者的多机构数据库中，回顾性地确定了甲状腺癌病例。通过泊松回归模型评估甲状腺癌的风险因素。
中位随访时间为 14.3 年（范围，0-41.2 年），28 例（1.4%）患者发生甲状腺恶性肿瘤。总体发病率（表示为每 10,000 人年的病例数）和 10 年累积甲状腺癌发生率分别为 9.6%和 0.26%。在 HL 后年龄≥35 岁接受颈部放疗的患者中未观察到甲状腺恶性肿瘤病例。HL 诊断时年龄<20 岁和女性是甲状腺癌的显著相关因素。HL 诊断时年龄<20 岁的女性在治疗后 10 年、≥10 年、≥15 年和≥20 年的发生率分别为 5、31、61 和 75 例/10,000 人年。在甲状腺癌诊断后中位随访 3.5 年时，26 例（93%）患者无病生存，1 例（4%）患者发生转移性疾病，1 例（4%）患者死于转移性疾病，分别在甲状腺癌诊断后 6 年和 3.6 年。
尽管 HL 幸存者患甲状腺癌的风险增加，但总体发病率较低。由于年轻且 HL 治疗后≥10 年的女性风险较高，且随着时间的推移而增加，因此对其进行常规甲状腺癌筛查可能有益。
