Malmgren Judith A, Calip Gregory S, Pyott Shawna M, Atwood Mary K, Kaplan Henry G
HealthStat Consulting, Inc., Seattle, WA, United States; University of Washington, Department of Epidemiology, Seattle, WA, United States.
University of Illinois at Chicago, Center for Pharmacoepidemiology and Pharmacoeconomic Research, Chicago, IL, United States.
Leuk Res. 2016 Aug;47:178-84. doi: 10.1016/j.leukres.2016.06.005. Epub 2016 Jun 23.
Therapy-related myelodysplastic syndrome (t-MDS) is a serious clinical disease occurring after breast cancer treatment.
A cohort of 11,684 invasive breast cancer (BC) patients from 1990-2014 were followed for incidence of t-MDS through institutional and the Surveillance, Epidemiology and End Results (SEER) Program registries. t-MDS cases were identified using ICD-O SEER registry codes, pathology and chart reports. Treatment, cytogenetics, and time from BC diagnosis to t-MDS and t-MDS diagnosis to last follow up or death were obtained. Incidence rate ratios were calculated using SEER national incidence rates for comparison.
27 cases of t-MDS post BC treatment were confirmed. 96% of cases were breast cancer stage I-II at diagnosis. All patients had received radiation treatment and 59% received adjuvant chemotherapy. Two patients were alive with no evidence of disease after treatment with stem cell transplantation (age 33 and 46). t-MDS incidence was 30 times the expected population rate among patients <55 years (RR 31.8, 95% CI 15.0, 60.8) with shorter time from t-MDS diagnosis to death (median survival time: <55: 8 months, 55-74: 26 months, 75+: 23 months).
We found elevated t-MDS risk especially among younger BC patients with stem cell transplantation the only observed curative treatment.
治疗相关的骨髓增生异常综合征（t-MDS）是乳腺癌治疗后发生的一种严重临床疾病。
对1990年至2014年的11684例浸润性乳腺癌（BC）患者队列进行随访，通过机构和监测、流行病学及最终结果（SEER）计划登记处追踪t-MDS的发病率。使用ICD-O SEER登记代码、病理和病历报告来识别t-MDS病例。获取治疗、细胞遗传学以及从BC诊断到t-MDS以及从t-MDS诊断到最后随访或死亡的时间。使用SEER国家发病率计算发病率比以进行比较。
确诊27例BC治疗后发生t-MDS的病例。96%的病例在诊断时为乳腺癌I-II期。所有患者均接受了放射治疗，59%接受了辅助化疗。两名患者在接受干细胞移植治疗后存活且无疾病证据（年龄分别为33岁和46岁）。<55岁患者的t-MDS发病率是预期人群发病率的30倍（RR 31.8，95% CI 15.0，60.8），从t-MDS诊断到死亡的时间较短（中位生存时间：<55岁：8个月，55 - 74岁：26个月，75岁及以上：23个月）。
我们发现t-MDS风险升高，尤其是在年轻的BC患者中，干细胞移植是唯一观察到的治愈性治疗方法。
