Wang Kang, Li Zhuyue, Chen Xingxing, Zhang Jianjun, Xiong Yongfu, Zhong Guochao, Shi Yang, Li Qing, Zhang Xiang, Li Hongyuan, Xiang Tingxiu, Foukakis Theodoros, Radivoyevitch Tomas, Ren Guosheng
Department of Endocrine and Breast Surgery, The First Affiliated hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
NPJ Breast Cancer. 2021 Mar 2;7(1):21. doi: 10.1038/s41523-021-00228-6.
The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term have increased risks of secondary hematologic malignancies (SHM), especially for low/intermediate-risk subsets with limited benefits from RT. DCIS patients in Surveillance, Epidemiology, and End Results (SEER) registries (1975-2016) were identified. Relative risks (RR), hazard ratio (HR), and standardized incidence ratios (SIR) were calculated to assess the SHM risk and subsequent survival times. SHM development, defined as a nonsynchronous SHM occurring ≥1 year after DCIS diagnosis, was our primary endpoint. Of 184,363 eligible patients with DCIS, 77,927 (42.3%) in the RT group, and 106,436 (57.7%) in the non-RT group, 1289 developed SHMs a median of 6.4 years (interquartile range, 3.5 to 10.3 years) after their DCIS diagnosis. Compared with DCIS patients in the non-RT group, RT was associated with increased early risk of developing acute lymphoblastic leukemia (ALL; hazard ratio, 3.15; 95% CI, 1.21 to 8.17; P = 0.02), and a delayed risk of non-Hodgkin lymphoma (NHL; hazard ratio, 1.33; 95% CI, 1.09 to 1.62; P < 0.001). This increased risk of ALL and NHL after RT was also observed in subgroup analyses restricted to low/intermediate-risk DCIS. In summary, our data suggest that RT after breast conserving surgery for DCIS patients should be cautiously tailored, especially for low and intermediate-risk patients. Long-term SHM surveillance after DCIS diagnosis is warranted.
继发性血液系统恶性肿瘤（SHM）发病率增加是癌症治疗后一种众所周知的、可能致命的并发症。对于接受外照射放疗（RT）且长期存活的乳腺导管原位癌（DCIS）患者，是否会增加继发性血液系统恶性肿瘤（SHM）的风险尚不清楚，尤其是对于从放疗中获益有限的低/中风险亚组。在监测、流行病学和最终结果（SEER）登记处（1975 - 2016年）中识别出DCIS患者。计算相对风险（RR）、风险比（HR）和标准化发病率比（SIR）以评估SHM风险和随后的生存时间。SHM的发生定义为在DCIS诊断后≥1年出现的非同步性SHM，这是我们的主要终点。在184,363例符合条件的DCIS患者中，放疗组77,927例（42.3%），非放疗组106,436例（57.7%），1289例在DCIS诊断后中位6.4年（四分位间距，3.5至10.3年）发生SHM。与非放疗组的DCIS患者相比，放疗与急性淋巴细胞白血病（ALL）早期发病风险增加相关（风险比，3.15；95%可信区间，1.21至8.17；P = 0.02），以及非霍奇金淋巴瘤（NHL）延迟发病风险增加（风险比，1.33；95%可信区间，1.09至1.62；P < 0.001）。在仅限于低/中风险DCIS的亚组分析中也观察到放疗后ALL和NHL风险增加。总之，我们的数据表明，对于DCIS患者保乳手术后的放疗应谨慎调整，尤其是对于低风险和中风险患者。DCIS诊断后进行长期SHM监测是必要的。
