Parzen Jacob S, Bates James E, Milano Michael T, Dhakal Sughosh
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
J Thorac Dis. 2016 Dec;8(12):3605-3613. doi: 10.21037/jtd.2016.12.59.
Survivors of malignant thymoma (MT) are at an increased risk of developing subsequent neoplasms. We compare overall survival (OS) between MT survivors who developed non-Hodgkin's lymphoma (NHL) or non-small cell lung cancer (NSCLC), and patients with first primary NHL (NHL-1) or NSCLC (NSCLC-1), respectively.
Using the population-based Surveillance, Epidemiology, and End Results (SEER) database for 1973 through 2013, 273,313 patients who had NHL-1, 21 patients with MT-NHL, 566,819 patients with NSCLC-1, and 38 patients with MT-NSCLC were identified. Univariate and multivariate models were used to assess the impact of various factors on OS.
The observed-to-expected ratio among MT patients was 2.63 [95% confidence interval (95% CI), 1.40-4.49; P<0.05] for NHL and 1.90 (95% CI, 1.33-3.63; P<0.05) for lung cancer. On univariate analysis, MT history did not worsen OS for NHL [hazard ratio (HR), 1.46; 95% CI, 0.87-2.47; P=0.16] or NSCLC (HR, 0.89; 95% CI, 0.61-1.29; P=0.53). On multivariate analysis, MT history was found to be an adverse prognostic indicator on OS for NHL (HR, 2.03; 95% CI, 1.20-3.42; P=0.008), but not NSCLC (HR, 0.87; 95% CI, 0.60-1.25; P=0.45).
Patients who develop NHL after MT have inferior survival than those with first primary NHL. A history of MT does not have an adverse prognostic impact on subsequent NSCLC. Clinicians must be aware of the intrinsic risk for subsequent malignancies after MT and the potential adverse impact of MT history on NHL prognosis but not NSCLC.
恶性胸腺瘤（MT）幸存者发生后续肿瘤的风险增加。我们比较了发生非霍奇金淋巴瘤（NHL）或非小细胞肺癌（NSCLC）的MT幸存者与分别患有原发性NHL（NHL-1）或NSCLC（NSCLC-1）患者的总生存期（OS）。
利用1973年至2013年基于人群的监测、流行病学和最终结果（SEER）数据库，确定了273313例NHL-1患者、21例MT-NHL患者、566819例NSCLC-1患者和38例MT-NSCLC患者。采用单因素和多因素模型评估各种因素对OS的影响。
MT患者中NHL的观察到预期比值为2.63[95%置信区间（95%CI），1.40 - 4.49；P<0.05]，肺癌为1.90（95%CI，1.33 - 3.63；P<0.05）。单因素分析显示，MT病史对NHL的OS没有不良影响[风险比（HR），1.46；95%CI，0.87 - 2.47；P = 0.16]或NSCLC（HR，0.89；95%CI，0.61 - 1.29；P = 0.53）。多因素分析发现，MT病史是NHL患者OS的不良预后指标（HR，2.03；95%CI，1.20 - 3.42；P = 0.008），但对NSCLC不是（HR，0.87；95%CI，0.60 - 1.25；P = 0.45）。
MT后发生NHL的患者生存率低于原发性NHL患者。MT病史对后续NSCLC没有不良预后影响。临床医生必须意识到MT后发生后续恶性肿瘤的内在风险以及MT病史对NHL预后而非NSCLC的潜在不良影响。
