Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima, Japan.
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
J Thorac Oncol. 2017 Nov;12(11):1696-1703. doi: 10.1016/j.jtho.2017.07.030. Epub 2017 Aug 10.
Extended survival outcomes from improved treatments for patients with cancer come with an increased risk for development of a metachronous second malignancy (MSM). We evaluated the incidence of MSM after successful treatment of SCLC and compared survival between patients with SCLC in whom MSM developed and those in whom it did not.
Selection criteria were a diagnosis of limited-stage SCLC and receipt of at least 45 Gy of radiotherapy and chemotherapy at a single institution in 1985-2012. MSM was defined as a tumor of a different histologic type than the primary that appeared more than 2 years after the diagnosis of SCLC.
Of 704 patients identified, 32 were excluded for lack of follow-up, 48 for having SCLC as MSM after treatment of another type of cancer, 37 for nonmelanoma skin cancer as MSM, and 46 for MSM within 2 years after SCLC diagnosis. Of the remaining 541 patients, 346 had recurrent SCLC, 180 had no second malignancy and no recurrence, and 15 (2.8%) had MSM (13 in a lung [eight adenocarcinomas and five squamous cell carcinomas], one sarcoma, and one acute myeloid leukemia). All 15 patients with MSM achieved complete response to the SCLC treatment. Overall survival was longer for patients with MSM than for patients with no other malignancies and no recurrence, with 10-year rates of 61.9% (95% confidence interval: 30.0%-82.6%) and 29.9% (95% confidence interval: 21.5%-38.6%), respectively (p = 0.03).
Long-term survivors after treatment for SCLC should be made aware of the risk for MSM and the necessity of follow-up.
癌症患者接受治疗后生存时间延长，随之而来的是发生异时性第二恶性肿瘤（MSM）的风险增加。我们评估了小细胞肺癌（SCLC）治疗成功后的 MSM 发生率，并比较了发生 MSM 和未发生 MSM 的 SCLC 患者的生存情况。
选择标准为诊断为局限期 SCLC，并于 1985 年至 2012 年在单一机构接受至少 45 Gy 的放化疗。MSM 定义为与原发性肿瘤组织学类型不同的肿瘤，出现在 SCLC 诊断后 2 年以上。
在确定的 704 例患者中，有 32 例因缺乏随访而被排除，48 例因在治疗另一种类型的癌症后 SCLC 为 MSM，37 例因非黑色素瘤皮肤癌为 MSM，46 例因 SCLC 诊断后 2 年内 MSM 而被排除。在剩余的 541 例患者中，有 346 例出现复发性 SCLC，180 例无第二恶性肿瘤和无复发，15 例（2.8%）发生 MSM（13 例在肺部[8 例腺癌和 5 例鳞状细胞癌]，1 例肉瘤，1 例急性髓细胞白血病）。所有 15 例 MSM 患者对 SCLC 治疗均达到完全缓解。发生 MSM 的患者总生存时间长于无其他恶性肿瘤和无复发的患者，10 年生存率分别为 61.9%（95%置信区间：30.0%-82.6%）和 29.9%（95%置信区间：21.5%-38.6%）（p=0.03）。
SCLC 治疗后长期生存者应意识到 MSM 的风险，并需要进行随访。
