Thomas Alexandra, Link Brian K, Altekruse Sean, Romitti Paul A, Schroeder Mary C
Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA.
J Natl Cancer Inst. 2017 Jun 1;109(6). doi: 10.1093/jnci/djw294.
Primary breast lymphoma (PBL) has gained attention with the description of breast implant-associated anaplastic large cell lymphoma (ALCL). Less is known about PBL incidence, treatment, and survival by lymphoma subtype.
The Surveillance, Epidemiology, and End Results (SEER) registry database was queried for patients with PBL as first malignancy, with attention to non-Hodgkin Lymphoma PBL subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma (MZL), and ALCL. Incidence was estimated by age and subtype with joinpoint analyses, along with initial local therapy. Five-year relative and overall survival estimates were compared using z and two-sided log-rank tests.
PBL incidence (per 1 000 000 women) increased from 0.66 (1975-1977) to 2.96 (2011-2013) with an annual percentage change (APC) of 5.3% (95% confidence interval [CI] = 3.8% to 6.9%, P < .001) from 1975 to 1999 and no statistically significant change thereafter. Incidence continues to increase for women younger than age 50 years (APC = 2.8%, 95% CI = 1.0% to 4.6%, P = .003) and for ALCL-PBL (APC = 11.8%, 95% CI = 0.2% to 24.9%, P = .047) and MZL-PBL (APC = 2.3%, 95% CI = -0.2% to 4.9%, P = .07), with the latter increasing significantly from 1995 to 2013 (APC = 7.5%, 95% CI = 3.4% to 11.8%, P = .001). Surgery and surgery with radiation declined from 2000 to 2013 as initial local therapy for PBL. Five-year relative survival for PBL improved markedly over four decades and was superior for stage I DLBCL-PBL and stage I follicular PBL than for corresponding systemic presentations.
PBL has increased in incidence over the last four decades and continues to increase for younger women and for some subtypes. The rise in imaging and procedures to the breast might enhance diagnostic sensitivity for PBL. Further study of the etiologies of PBL is needed.
随着乳腺植入物相关间变性大细胞淋巴瘤（ALCL）的描述，原发性乳腺淋巴瘤（PBL）受到了关注。关于PBL的发病率、治疗及按淋巴瘤亚型的生存率，人们了解较少。
查询监测、流行病学和最终结果（SEER）登记数据库中PBL作为首发恶性肿瘤的患者，关注非霍奇金淋巴瘤PBL亚型：弥漫性大B细胞淋巴瘤（DLBCL）、滤泡性淋巴瘤、边缘区淋巴瘤（MZL）和ALCL。通过年龄和亚型并采用连接点分析估计发病率，以及初始局部治疗情况。使用z检验和双侧对数秩检验比较5年相对生存率和总生存率估计值。
PBL发病率（每100万女性）从1975 - 1977年的0.66增至2011 - 2013年的2.96，1975年至1999年年增长率（APC）为5.3%（95%置信区间[CI]=3.8%至6.9%，P<0.001），此后无统计学显著变化。50岁以下女性的发病率持续上升（APC = 2.8%，95% CI = 1.0%至4.6%，P = 0.003），ALCL - PBL（APC = 11.8%，95% CI = 0.2%至24.9%，P = 0.047）和MZL - PBL（APC = 2.3%，95% CI = -0.2%至4.9%，P = 0.07）也是如此，后者在1995年至2013年显著上升（APC = 7.5%，95% CI = 3.4%至11.8%，P = 0.001）。2000年至2013年，手术及手术联合放疗作为PBL初始局部治疗的情况有所下降。40年来，PBL的5年相对生存率显著提高，I期DLBCL - PBL和I期滤泡性PBL的5年相对生存率高于相应的全身性表现。
在过去四十年中，PBL发病率有所上升，年轻女性及某些亚型的发病率仍在继续上升。乳腺影像学检查和手术操作的增加可能提高了PBL的诊断敏感性。需要对PBL的病因进行进一步研究。
