Mensi Carolina, Stella Simona, Dallari Barbara, Rugarli Sabrina, Pesatori Angela Cecilia, Ceresoli Giovanni Luca, Consonni Dario
Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Department of Clinical and Community Science, Università degli Studi di Milano, 20122 Milan, Italy.
Cancers (Basel). 2023 Mar 13;15(6):1746. doi: 10.3390/cancers15061746.
The presence of a second primary cancer (SPC) in patients with pleural mesothelioma (PM) may impact overall survival and suggest a common mechanism of carcinogenesis or an underlying germline genetic alteration.
We evaluated the occurrence of SPCs within PM cases collected from 2000 to 2018 by the Lombardy Mesothelioma Registry and their prognostic implications. Kaplan-Meier analysis was performed to estimate median survival times, together with univariate and multivariate Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) of death.
The median overall survival (OS) of the entire study population (N = 6646) was 10.9 months (95% CI: 10.4-11.2); patient age and histotype were the strongest prognostic factors. No substantial survival difference was observed by the presence of an SPC (10.5 months in 1000 patients with an SPC vs. 10.9 months in 5646 patients in the non-SPC group, HR 1.03, = 0.40). Shorter OS in the SPC group was only observed in 150 patients with the non-epithelioid subtype (median OS of 5.4 vs. 7.1 months, HR 1.21, = 0.03).
The diagnosis of an SPC did not influence the outcome of PM patients in the overall study population but was associated with shorter OS in non-epithelioid cases. Further studies are needed to clarify the role of SPCs as markers of genetic susceptibility in mesothelioma.
胸膜间皮瘤（PM）患者中第二原发性癌症（SPC）的存在可能会影响总生存期，并提示存在共同的致癌机制或潜在的种系基因改变。
我们评估了伦巴第间皮瘤登记处2000年至2018年收集的PM病例中SPC的发生情况及其预后意义。采用Kaplan-Meier分析估计中位生存时间，并采用单因素和多因素Cox回归模型估计死亡风险比（HR）和95%置信区间（CI）。
整个研究人群（N = 6646）的中位总生存期（OS）为10.9个月（95%CI：10.4 - 11.2）；患者年龄和组织学类型是最强的预后因素。SPC的存在未观察到明显的生存差异（1000例有SPC的患者中位生存期为10.5个月，非SPC组5646例患者为10.9个月，HR 1.03，P = 0.40）。仅在150例非上皮样亚型患者中观察到SPC组的OS较短（中位OS为5.4个月对7.1个月，HR 1.21，P = 0.03）。
SPC的诊断在整个研究人群中并未影响PM患者的预后，但在非上皮样病例中与较短的OS相关。需要进一步研究以阐明SPC作为间皮瘤遗传易感性标志物的作用。
