Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY.
Clin Lymphoma Myeloma Leuk. 2020 May;20(5):316-323.e2. doi: 10.1016/j.clml.2019.12.017. Epub 2020 Jan 8.
The increased risk for second malignancies after Hodgkin lymphoma (HL) diagnosis is well known. However, to our knowledge, no study has investigated the outcomes of patients diagnosed with HL after an antecedent malignancy (HL-2). We aimed to investigate overall survival (OS), disease-specific survival (DSS), and correlates of survival in HL-2 using the Surveillance, Epidemiology and End Results (SEER) database.
HL-2 patients (n = 821) identified from the 2000-2014 SEER-18 registries were compared to first primary HL patients (HL-1, n = 31,355) from the same registries. Multivariable, propensity score-matched (PSM), and competing risks regression analyses were conducted to assess the effect of antecedent malignancy on survival.
Hematologic (n = 309, 37.6%), prostate (n = 169, 20.6%), and breast (n = 76, 9.3%) malignancies were common antecedent malignancies in HL-2. Median latency between antecedent malignancy and HL diagnosis was 39 months. Median ages at HL diagnosis for HL-1 and HL-2 were 36 and 66 years, respectively (P < .001). The 5-year OS and HL-DSS rates for HL-2 versus HL-1 were 53.2% versus 82.7% and 79.1% versus 90.9%, respectively (P < .001). On multivariable analysis, antecedent malignancy was associated with decreased OS (hazard ratio [HR] = 1.27; 95% confidence interval [CI], 1.13-1.42; P < .001). With PSM balancing across covariables, antecedent malignancy was associated with decrements in HL-DSS (HR = 1.46; 95% CI, 1.12-1.92; P = .006) and OS (HR = 2.09; 95% CI, 1.74-2.51; P < .001).
The decrement in DSS in HL-2 relative to HL-1 may be related to biological differences in HL, age, and/or other unanalyzed factors. Further study of HL-2 patients is warranted.
霍奇金淋巴瘤（HL）诊断后发生第二恶性肿瘤的风险增加是众所周知的。然而，据我们所知，尚无研究调查过先前患有恶性肿瘤（HL-2）后诊断为 HL 的患者的结局。我们旨在使用监测、流行病学和最终结果（SEER）数据库研究 HL-2 患者的总生存（OS）、疾病特异性生存（DSS）和生存相关因素。
从 2000-2014 年 SEER-18 登记处中确定 HL-2 患者（n=821），并与来自同一登记处的初次原发性 HL 患者（HL-1，n=31355）进行比较。采用多变量、倾向评分匹配（PSM）和竞争风险回归分析来评估先前恶性肿瘤对生存的影响。
血液系统（n=309，37.6%）、前列腺（n=169，20.6%）和乳腺（n=76，9.3%）恶性肿瘤是 HL-2 中常见的先前恶性肿瘤。在前述恶性肿瘤与 HL 诊断之间的中位潜伏期为 39 个月。HL-1 和 HL-2 的 HL 诊断中位年龄分别为 36 岁和 66 岁（P<0.001）。HL-2 与 HL-1 相比，5 年 OS 和 HL-DSS 率分别为 53.2%和 82.7%和 79.1%和 90.9%（P<0.001）。多变量分析显示，先前患有恶性肿瘤与 OS 降低相关（风险比[HR]为 1.27；95%置信区间[CI]，1.13-1.42；P<0.001）。通过 PSM 平衡协变量后，先前患有恶性肿瘤与 HL-DSS（HR=1.46；95%CI，1.12-1.92；P=0.006）和 OS（HR=2.09；95%CI，1.74-2.51；P<0.001）降低相关。
HL-2 中与 HL-1 相比 DSS 的降低可能与 HL、年龄和/或其他未分析因素的生物学差异有关。需要进一步研究 HL-2 患者。
