Nishikubo C Y, Kunkel L A, Figlin R, Belldegrun A, Rosen P, Elashoff R, Wang H, Territo M C
Department of Medicine, University of California, Los Angeles, USA.
Cancer. 1996 Dec 1;78(11):2421-6.
Second primary malignancies have been described in patients with both solid tumors and hematologic malignancies. However, an association between renal cell carcinoma and lymphoid malignancies has rarely been described. Eight patients with both disorders are described and possible explanations for the association are reviewed.
A retrospective review of records from patients with renal cell carcinoma, lymphoma, leukemia, or myeloma discharged from the University of California at Los Angeles between July 1, 1993 and June 30, 1995 was performed. Renal cell carcinoma was diagnosed in 186 patients, whereas 405 had a lymphoid malignancy. Eight patients with both disorders were identified.
In four of the eight patients, the renal cell carcinoma was diagnosed prior to their hematologic malignancy, whereas in the remaining four patients, the lymphoid malignancy was diagnosed first. Renal cell carcinoma is observed in the general population in 12.5 persons per 100,000 and hematologic malignancies in 31.8 per 100,000. The number of cases of lymphoid malignancies expected in the 186 renal cell carcinoma patients is lower than the 4 cases actually observed (P < 0.01). Likewise, the number of renal tumors expected in the 405 patients with hematologic malignancies is fewer than the 4 cases observed (P < 0.01).
The incidence of renal cell carcinoma and lymphoid malignancy occurring in the same patient is higher than that expected in the general population. This association cannot be explained by treatment-related development of a second malignancy. A common genetic mutation or an immunomodulatory role of the first malignancy predisposing to the second are possibilities but further investigation is warranted.
实体瘤和血液系统恶性肿瘤患者中均有第二原发性恶性肿瘤的报道。然而，肾细胞癌与淋巴系统恶性肿瘤之间的关联却鲜有描述。本文描述了8例同时患有这两种疾病的患者，并对这种关联的可能解释进行了综述。
对1993年7月1日至1995年6月30日期间从加利福尼亚大学洛杉矶分校出院的肾细胞癌、淋巴瘤、白血病或骨髓瘤患者的记录进行回顾性研究。186例患者被诊断为肾细胞癌，405例患有淋巴系统恶性肿瘤。确定了8例同时患有这两种疾病的患者。
8例患者中有4例肾细胞癌在血液系统恶性肿瘤之前被诊断，而其余4例患者首先被诊断为淋巴系统恶性肿瘤。普通人群中肾细胞癌的发病率为每10万人中有12.5人，血液系统恶性肿瘤的发病率为每10万人中有31.8人。186例肾细胞癌患者中预期的淋巴系统恶性肿瘤病例数低于实际观察到的4例（P<0.01）。同样，405例血液系统恶性肿瘤患者中预期的肾肿瘤病例数少于观察到的4例（P<0.01）。
同一患者中肾细胞癌和淋巴系统恶性肿瘤的发生率高于普通人群的预期。这种关联不能用与治疗相关的第二原发性恶性肿瘤的发生来解释。可能存在共同的基因突变或第一种恶性肿瘤的免疫调节作用易导致第二种恶性肿瘤，但需要进一步研究。
