Zhang A Y, Judson I, Benson C, Wunder J S, Ray-Coquard I, Grimer R J, Quek R, Wong E, Miah A B, Ferguson P C, Dufresne A, Teh J Y H, Stockler M, Tattersall M H N
The University of Sydney, Sydney 2006, Australia.
Chris O'Brien Lifehouse, Sydney 2050, Australia.
Br J Cancer. 2017 Jul 25;117(3):326-331. doi: 10.1038/bjc.2017.198. Epub 2017 Jun 27.
An increasing number and proportion of cancer patients with apparently localised disease are treated with chemotherapy and radiation therapy in contemporary oncology practice. In a pilot study of radiation-induced sarcoma (RIS) patients, we demonstrated that chemotherapy was associated with a reduced time to development of RIS. We now present a multi-centre collaborative study to validate this association.
This was a retrospective cohort study of RIS cases across five large international sarcoma centres between 1 January 2000 to 31 December 2014. The primary endpoint was time to development of RIS.
We identified 419 patients with RIS. Chemotherapy for the first malignancy was associated with a shorter time to RIS development (HR 1.37; 95% CI: 1.08-1.72; P=0.009). In the multi-variable model, older age (HR 2.11; 95% CI 1.83-2.43; P<0.001) and chemotherapy for the first malignancy (HR 1.61; 95% CI 1.26-2.05; P<0·001) were independently associated with a shorter time to RIS. Anthracyclines and alkylating agents significantly contribute to the effect.
This study confirms an association between chemotherapy given for the first malignancy and a shorter time to development of RIS.
在当代肿瘤学实践中，越来越多表面上疾病局限的癌症患者接受化疗和放疗。在一项关于放射性肉瘤（RIS）患者的初步研究中，我们证明化疗与RIS发生时间缩短有关。我们现在开展一项多中心合作研究以验证这种关联。
这是一项对2000年1月1日至2014年12月31日期间五个大型国际肉瘤中心的RIS病例进行的回顾性队列研究。主要终点是RIS发生时间。
我们确定了419例RIS患者。首次恶性肿瘤的化疗与RIS发生时间缩短有关（风险比1.37；95%置信区间：1.08 - 1.72；P = 0.009）。在多变量模型中，年龄较大（风险比2.11；95%置信区间1.83 - 2.43；P < 0.001）和首次恶性肿瘤的化疗（风险比1.61；95%置信区间1.26 - 2.05；P < 0.001）与RIS发生时间缩短独立相关。蒽环类药物和烷化剂对这种影响有显著作用。
本研究证实了首次恶性肿瘤的化疗与RIS发生时间缩短之间的关联。
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