Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China.
Cancer Med. 2023 Apr;12(7):8038-8049. doi: 10.1002/cam4.5592. Epub 2023 Jan 9.
To our knowledge, the different situations of identifying second primary malignant tumors (SPMTs) in lymphoma patients with synchronous solid tumors remain to be comprehensively investigated.
We retrospectively collected information pertaining to lymphoma patients with synchronous solid tumors (diagnosed within 6 months) at Peking University Cancer Hospital & Institute between 2009 and 2019. The non-parametric Aalen-Johansen estimator was applied to calculate cumulative incidence function in the competing risk model. Furthermore, propensity score-matched analysis was performed to compare survival differences in lymphoma patients with or without synchronous solid tumors.
Thirty-eight patients were enrolled. There were three situations of identifying SPMTs. First, in 15 patients (39.5%), SPMTs were identified before the initiation of any treatment. Among them, priority was given to anti-lymphoma treatment in case of only three patients. Second, in 17 patients (44.7%), SPMTs were unexpectedly detected on surgical specimen assessment; of them, 13 received anti-lymphoma treatment after surgery. Third, in six patients (15.8%), SPMTs were identified after the outset of treatment for the primary tumor; in this population, three of four patients with lymphoma switched toward the treatment plan for SPMTs. The 5-year overall survival was 58.7%. The cumulative incidence function within 5 years was 26.6% for lymphoma and 14.7% for other solid tumors. The early identification of SPMTs was associated with better outcomes (p = 0.048). After balancing the baseline characteristics, no differences in survival were observed between lymphoma patients with and without synchronous solid tumors (p = 0.664).
This is the first study to present the different situations of identifying SPMTs in lymphoma patients with synchronous solid tumors. In only <50% patients, SPMTs were identifiable at baseline. SPMT identification at different situations may make it difficult to choose the optimal therapeutic option, which may consequently impact patient survival.
据我们所知，在同时患有淋巴瘤和实体瘤的患者中，确定第二原发性恶性肿瘤（SPMT）的不同情况仍需要全面研究。
我们回顾性地收集了 2009 年至 2019 年期间在北京大学肿瘤医院和研究所同时诊断为淋巴瘤和实体瘤（诊断时间在 6 个月内）的患者信息。应用非参数 Aalen-Johansen 估计量计算竞争风险模型中的累积发生率函数。此外，还进行了倾向评分匹配分析，以比较有或无同步实体瘤的淋巴瘤患者的生存差异。
共纳入 38 例患者。有三种确定 SPMT 的情况。首先，在 15 例（39.5%）患者中，在开始任何治疗之前就已经确定了 SPMT。其中，仅 3 例患者优先进行抗淋巴瘤治疗。其次，在 17 例（44.7%）患者中，SPMT 是在手术标本评估时意外发现的；其中 13 例患者在手术后接受了抗淋巴瘤治疗。第三，在 6 例（15.8%）患者中，在原发肿瘤治疗开始后才发现 SPMT；在这部分人群中，4 例中有 3 例淋巴瘤患者转向 SPMT 的治疗方案。5 年总生存率为 58.7%。5 年内淋巴瘤的累积发生率为 26.6%，其他实体肿瘤的累积发生率为 14.7%。早期识别 SPMT 与更好的预后相关（p=0.048）。在平衡了基线特征后，有和无同步实体瘤的淋巴瘤患者之间的生存差异无统计学意义（p=0.664）。
这是第一项研究同时患有淋巴瘤和实体瘤的患者中确定 SPMT 的不同情况的研究。在<50%的患者中，基线时可识别 SPMT。在不同情况下识别 SPMT 可能使选择最佳治疗方案变得困难，从而影响患者的生存。
