Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.
Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
Br J Haematol. 2019 Apr;185(2):232-239. doi: 10.1111/bjh.15777. Epub 2019 Jan 31.
Improvement of survival in lymphocytic leukaemia has been accompanied by the occurrence of second primary cancer (SPCs). Based on Swedish Family Cancer Database, we applied bi-directional analyses in which relative risks (RRs) were calculated for any SPCs in patients with chronic lymphocytic leukaemia (CLL), acute lymphoblastic leukaemia (ALL) and hairy cell leukaemia (HCL) and the risks of these leukaemias as SPCs. After CLL, RRs were significant for 20 SPCs, and high for skin squamous cell cancer (24·58 for in situ and 7·63 for invasive), Merkel cell carcinoma (14·36), Hodgkin lymphoma (7·16) and Kaposi sarcoma (6·76). Conversely, 15 CLL cancer pairs were reciprocally increased. The increased risks were reciprocal for ALL and four cancers. RR for ALL was 15·35 after myeloid neoplasia. HCL showed reciprocally increased RRs with non-Hodgkin lymphoma and melanoma. The concordance between RRs for bi-directional associations between CLL and different cancers, and HCL and different cancers was highly significant. For CLL (also for HCL), the bi-directional risks with skin cancers and other immune-related cancers suggest the probable involvement of immune dysfunction. For ALL, treatment may contribute to risks of multiple SPCs. Increased risk of ALL after haematological neoplasms may indicate bone marrow dysfunction. These findings may help guide treatment decisions and prognostic assessment.
淋巴细胞白血病患者的存活率提高的同时，也出现了第二原发癌（SPC）。我们基于瑞典家族癌症数据库，采用双向分析方法，计算了慢性淋巴细胞白血病（CLL）、急性淋巴细胞白血病（ALL）和毛细胞白血病（HCL）患者的任何 SPC 的相对风险（RR），以及这些白血病作为 SPC 的风险。CLL 之后，20 种 SPC 的 RR 具有显著意义，皮肤鳞状细胞癌的风险较高（原位 24.58，侵袭性 7.63）、默克尔细胞癌（14.36）、霍奇金淋巴瘤（7.16）和卡波西肉瘤（6.76）。相反，15 对 CLL 癌症呈相互增加。ALL 和四种癌症的风险呈相互增加。骨髓增生性肿瘤后 ALL 的 RR 为 15.35。HCL 与非霍奇金淋巴瘤和黑色素瘤呈相互增加的 RR。CLL 与不同癌症之间的双向关联以及 HCL 与不同癌症之间的 RR 一致性非常显著。对于 CLL（也适用于 HCL），与皮肤癌和其他免疫相关癌症的双向风险表明可能涉及免疫功能障碍。对于 ALL，治疗可能会导致多种 SPC 的风险增加。血液系统恶性肿瘤后 ALL 风险增加可能表明骨髓功能障碍。这些发现可能有助于指导治疗决策和预后评估。
