Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2018 Mar 1;100(3):687-694. doi: 10.1016/j.ijrobp.2017.11.011. Epub 2017 Nov 14.
To compare rates of secondary acute leukemia between sarcoma patients and the general population, using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry, and to examine whether various patient, tumor, and treatment factors were associated with development of a secondary acute leukemia.
Patients with a primary diagnosis of connective tissue malignancy between 1973 and 2008 in the SEER database were included. Multivariable competing risk analysis was used to determine risk factors associated with subsequent development of acute leukemia. Using observed-to-expected ratios, we compared incidence rates of secondary acute leukemia between sarcoma patients and the general population.
A total of 72,945 patients were identified, with median follow-up of 131 months. On multivariable competing risk analysis, factors associated with increased risk of secondary acute leukemia included receipt of radiation therapy (hazard ratio [HR] 1.67, P=.02), distant disease (HR 2.67, P=.004), male gender (HR 1.53, P=.03), year of diagnosis (HR 0.98, P=.049), and Ewing sarcoma histology (HR 9.95, P < .0001) and osteosarcoma histology (HR 5.06, P=.0001). The observed-to-expected ratio for development of a secondary acute leukemia was 3.67 (95% confidence interval [CI] 1.95-6.28), 3.41 (95% CI 2.73-4.20), and 1.6 (95% CI 1.38-8.19) for acute lymphocytic leukemia, acute myeloid leukemia, and acute monocytic leukemia, respectively. The 10-year cumulative incidence of secondary acute leukemia for patients who did and did receive radiation therapy was 0.3% versus 0.1% (P=.02).
Patients treated for sarcoma, in particular those with Ewing sarcoma and osteosarcoma histology, seem to have a higher incidence of secondary acute leukemia as compared with the general population. Treatment factors including radiation therapy and chemotherapy seem to play a role in this increased risk, although the absolute incidence nevertheless remains very small.
利用美国国家癌症研究所监测、流行病学和最终结果（SEER）登记处的数据，比较肉瘤患者与普通人群中继发性急性白血病的发生率，并研究各种患者、肿瘤和治疗因素是否与继发性急性白血病的发生相关。
纳入 SEER 数据库中 1973 年至 2008 年间患有结缔组织恶性肿瘤的患者。采用多变量竞争风险分析确定与急性白血病后续发展相关的危险因素。使用观察到的与预期的比值，我们比较了肉瘤患者和普通人群中继发性急性白血病的发病率。
共确定了 72945 例患者，中位随访时间为 131 个月。多变量竞争风险分析显示，与继发性急性白血病风险增加相关的因素包括放疗（风险比 [HR] 1.67，P=.02）、远处转移（HR 2.67，P=.004）、男性（HR 1.53，P=.03）、诊断年份（HR 0.98，P=.049）、尤文肉瘤组织学（HR 9.95，P <.0001）和骨肉瘤组织学（HR 5.06，P=.0001）。观察到的继发性急性白血病发病的预期比为 3.67（95%置信区间 [CI] 1.95-6.28）、3.41（95% CI 2.73-4.20）和 1.6（95% CI 1.38-8.19），分别为急性淋巴细胞白血病、急性髓细胞白血病和急性单核细胞白血病。接受和未接受放疗的患者 10 年继发性急性白血病累积发生率分别为 0.3%和 0.1%（P=.02）。
接受肉瘤治疗的患者，特别是患有尤文肉瘤和骨肉瘤组织学的患者，继发性急性白血病的发生率似乎高于普通人群。包括放疗和化疗在内的治疗因素似乎在这种风险增加中起作用，但绝对发生率仍然非常小。
