Travis L B, Curtis R E, Glimelius B, Holowaty E, Van Leeuwen F E, Lynch C F, Adami J, Gospodarowicz M, Wacholder S, Inskip P
Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, Md.
J Natl Cancer Inst. 1993 Dec 1;85(23):1932-7. doi: 10.1093/jnci/85.23.1932.
Patients with non-Hodgkin's lymphoma (NHL) are at increased risk for second cancers. Few studies, however, include long-term survivors, and none report risk for second cancer among NHL patients surviving 15 or more years.
Our aim was to examine the pattern of second cancers among long-term survivors of NHL.
A cohort of 6171 patients diagnosed with NHL as a first primary cancer and who survived 2 or more years was identified within population-based tumor registries in Sweden, Ontario, and Iowa and within the affiliated tumor registry of The Netherlands Cancer Institute. Nearly 1000 NHL patients lived 15 or more years after diagnosis. Tumor registry files were searched for new invasive primary malignancies.
Second cancers were reported in 541 subjects (observed-to-expected ratio [O/E] = 1.37; 95% confidence interval = 1.26-1.49), with significant excesses seen for all solid tumors (O/E = 1.28), acute nonlymphocytic leukemia (O/E = 4.83), melanoma (O/E = 2.38), Hodgkin's disease (O/E = 12.0), and cancers of the lung (O/E = 1.36), brain (O/E = 2.33), kidney (O/E = 2.07), and bladder (O/E = 1.77). Among 15-year survivors, significantly increased risks persisted for all second cancers (O/E = 1.45), solid tumors (O/E = 1.37), bladder cancer (O/E = 3.24), and Hodgkin's disease (O/E = 25.0). The actuarial risk of developing a second cancer 3-20 years after diagnosis of NHL was 21%, compared with a population expected cumulative risk of 15%.
Patients with NHL continue to be at significantly elevated risk of second primary cancer for up to two decades following diagnosis. The pattern of risk suggests the influence of treatment as well as factors associated with the underlying disease.
Quantitative studies of second cancer following NHL are needed to clarify the role of antecedent therapy, shared risk factors, host susceptibility, and other etiologic and diagnostic influences. Despite the generally advanced age of patients with NHL, the persistently elevated risk of second cancers should alert clinicians to the importance of continued medical surveillance.
非霍奇金淋巴瘤（NHL）患者发生第二原发癌的风险增加。然而，很少有研究纳入长期生存者，且没有研究报告NHL生存15年及以上患者发生第二原发癌的风险。
我们的目的是研究NHL长期生存者中第二原发癌的发生模式。
在瑞典、安大略省和爱荷华州基于人群的肿瘤登记处以及荷兰癌症研究所附属肿瘤登记处中，确定了6171例被诊断为NHL作为第一原发癌且生存2年及以上的患者队列。近1000例NHL患者在诊断后存活了15年及以上。在肿瘤登记档案中搜索新的侵袭性原发性恶性肿瘤。
541例受试者报告发生了第二原发癌（观察/预期比[O/E]=1.37；95%置信区间=1.26-1.49），所有实体瘤（O/E=1.28）、急性非淋巴细胞白血病（O/E=4.83）、黑色素瘤（O/E=2.38）、霍奇金病（O/E=12.0）以及肺癌（O/E=1.36）、脑癌（O/E=2.33）、肾癌（O/E=2.07）和膀胱癌（O/E=1.77）的发生风险均显著增加。在15年生存者中，所有第二原发癌（O/E=1.45）、实体瘤（O/E=1.37）、膀胱癌（O/E=3.24）和霍奇金病（O/E=25.0）的风险仍显著增加。NHL诊断后3-20年发生第二原发癌的精算风险为21%，而人群预期累积风险为15%。
NHL患者在诊断后长达二十年的时间里，发生第二原发癌的风险仍显著升高。风险模式提示了治疗以及与基础疾病相关因素的影响。
需要对NHL后的第二原发癌进行定量研究，以阐明前期治疗、共同风险因素、宿主易感性以及其他病因和诊断影响的作用。尽管NHL患者普遍年龄较大，但第二原发癌持续升高的风险应提醒临床医生持续医学监测的重要性。
