Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York.
Cancer. 2015 May 1;121(9):1436-45. doi: 10.1002/cncr.29231. Epub 2015 Jan 8.
Survivors of Hodgkin lymphoma (HL) are at an increased risk of developing second malignancies. To the authors' knowledge, the risks of head and neck cancer (HNC) after HL and subsequent survival have not been thoroughly investigated.
From the US population-based Surveillance, Epidemiology, and End Results (SEER) database for 1973 through 2011, survivors of HL who developed HNC as a second cancer were analyzed. Patients with a first primary HNC were used as a comparison group. Observed-to-expected ratios and summary statistics were performed on patients with HL with squamous cell carcinoma (HL-SCC) and salivary gland cancer (HL-SGC). The impact of HL history on overall survival was assessed using a multivariate Cox proportional hazards model.
The observed-to-expected ratio for SCC among patients with HL was 1.73 (95% confidence interval [95% CI], 1.36-2.16; P<.05), whereas it was 8.56 for SGC (95% CI, 5.82-12.15; P<.05). Using Cox proportional hazards modeling, a history of HL was found to be an adverse prognostic factor for overall survival for SCC (hazard ratio, 1.37; 95% CI, 1.08-1.73 [P = .009]) but not SGC (hazard ratio, 1.21; 95% CI, 0.82-1.79 [P = .34]). The inferior survival of the patients in the HL-SCC cohort appears to be attributable to more deaths from HL and other malignancies diagnosed after SCC.
There is a significantly increased risk of salivary and nonsalivary HNC after HL, and worse survival for patients with HL-SCC versus those with a first primary SCC. Clinicians should be aware of the risks of HNC after HL. In the absence of evidence-based criteria, the authors recommend that survivors of HL undergo periodic head and neck examination.
霍奇金淋巴瘤（HL）幸存者发生第二恶性肿瘤的风险增加。据作者所知，HL 后头颈部癌症（HNC）的风险及其随后的生存情况尚未得到彻底研究。
从 1973 年至 2011 年，作者分析了美国基于人群的监测、流行病学和最终结果（SEER）数据库中 HL 幸存者作为第二癌症发生 HNC 的情况。将患有第一原发 HNC 的患者作为对照组。对患有 HL 鳞状细胞癌（HL-SCC）和唾液腺癌（HL-SGC）的患者进行观察到的与预期的比值和汇总统计分析。使用多变量 Cox 比例风险模型评估 HL 病史对总生存的影响。
HL 患者 SCC 的观察到的与预期的比值为 1.73（95%置信区间[95%CI]，1.36-2.16；P<.05），而 SGC 为 8.56（95%CI，5.82-12.15；P<.05）。使用 Cox 比例风险模型，HL 病史被发现是 SCC 总生存的不良预后因素（风险比，1.37；95%CI，1.08-1.73[P = .009]），但不是 SGC（风险比，1.21；95%CI，0.82-1.79[P = .34]）。HL-SCC 队列中患者的生存较差似乎归因于 SCC 后诊断出的 HL 和其他恶性肿瘤导致的更多死亡。
HL 后发生唾液腺和非唾液腺 HNC 的风险显著增加，与初发 SCC 患者相比，HL-SCC 患者的生存更差。临床医生应意识到 HL 后发生 HNC 的风险。在缺乏循证标准的情况下，作者建议 HL 幸存者定期进行头颈部检查。
