Xu Peng, Lin Yan, Gu Weiying, Li Zhenyu
Key Laboratory of Bone Marrow Stem Cell, Blood Disease Institute, Xuzhou Medical University, Xuzhou, China.
Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
Discov Oncol. 2025 Jun 9;16(1):1034. doi: 10.1007/s12672-025-02897-2.
An increased risk of secondary primary malignancies (SPMs) has been shown in diffuse large B-cell lymphoma (DLBCL) patients after treatment. However, research on SPM outcomes in DLBCL patients is limited.
Utilizing the population-based Surveillance, Epidemiology, and End Results Registry (SEER), the authors examined the characteristics, overall survival (OS), and treatments in DLBCL patients who developed secondary cancers of the breast, prostate, lung, colon/rectum, bladder cancers, melanoma, myeloma, and acute leukemia. Each patient was matched by age, sex, race, year of diagnosis, and stage to 50 controls from a general population diagnosed with a non-DLBCL primary the cancer.
Patients with antecedent DLBCL who developed lung cancer (37.3% vs. 18.3%, P < 0.001) or colon/rectum cancer (45.5% vs. 39.6%, P = 0.032) were more commonly diagnosed at an early stage. Compared with patients in the control group, patients with antecedent DLBCL who developed prostate cancer, melanoma, myeloma, and acute leukemia had significantly worse OS. Conversely, patients who developed lung cancer after their antecedent DLBCL diagnosis showed markedly better OS. Amongst patients with antecedent DLBCL aged over 60, intensive therapy was associated with improved OS compared to supportive care in those being treated for a SPM diagnosis of breast, prostate, lung, colon/rectum, melanoma or bladder cancer, but not myeloma or acute leukemia. The rates of surgical resection were the same between patients with antecedent DLBCL and those in the control group, except for lower prostatectomy rates and higher lobectomy rates among patients with antecedent DLBCL.
Our findings can assist clinicians in better understanding the survival outcomes of SPMs among patients with antecedent DLBCL while suggesting that long-term follow-up might be useful to detect DLBCL survivors who developed SPMs.
研究表明，弥漫性大B细胞淋巴瘤（DLBCL）患者治疗后发生第二原发性恶性肿瘤（SPM）的风险增加。然而，关于DLBCL患者SPM结局的研究有限。
作者利用基于人群的监测、流行病学和最终结果登记处（SEER）的数据，研究了发生乳腺癌、前列腺癌、肺癌、结肠/直肠癌、膀胱癌、黑色素瘤、骨髓瘤和急性白血病等继发性癌症的DLBCL患者的特征、总生存期（OS）和治疗情况。将每名患者按年龄、性别、种族、诊断年份和分期与50名来自诊断为非DLBCL原发性癌症的普通人群的对照进行匹配。
既往有DLBCL病史且发生肺癌（37.3%对18.3%，P<0.001）或结肠/直肠癌（45.5%对39.6%，P=0.032）的患者更常被诊断为早期癌症。与对照组患者相比，既往有DLBCL病史且发生前列腺癌、黑色素瘤、骨髓瘤和急性白血病的患者OS明显更差。相反，既往有DLBCL诊断后发生肺癌的患者OS明显更好。在60岁以上既往有DLBCL病史的患者中，对于因SPM诊断为乳腺癌、前列腺癌、肺癌、结肠/直肠癌、黑色素瘤或膀胱癌而接受治疗的患者，与支持性治疗相比，强化治疗与OS改善相关，但对于骨髓瘤或急性白血病患者则不然。既往有DLBCL病史的患者与对照组患者的手术切除率相同，只是既往有DLBCL病史的患者前列腺切除术率较低，肺叶切除术率较高。
我们的研究结果可帮助临床医生更好地了解既往有DLBCL病史的患者中SPM的生存结局，同时表明长期随访可能有助于发现发生SPM的DLBCL幸存者。
