恶性血液病并发第二肿瘤的临床特征与危险因素分析(附33例)

Clinical characteristics and risk factors analysis of patients with hematological malignancies associated with secondary primary malignancy( 33 cases)

目的:探讨恶性血液病并发第二肿瘤患者的临床特征、可能的发病机制及危险因素分析。方法:收集自2013年1月至2017年4月于我院血液科就诊的33例罹患两种及以上恶性肿瘤(其中一种为血液系统肿瘤)患者的临床资料,对其进行回顾性分析。结果:33例患者中男性23例,女性10例,第二肿瘤中位发病年龄59岁,其中同时性多原发肿瘤6例,异时性多原发肿瘤27例,双重恶性血液病共8例,治疗相关性急性髓系白血病10例,三原发恶性肿瘤患者2例;33例患者中5例于院内死亡(病程7~12个月)。结论:多原发恶性肿瘤中以双原发、异时性恶性肿瘤多见;第二肿瘤中位发病年龄偏大,其确切病因及发病机制尚不明确,患者多有复杂染色体核型,预后不良;发生第二肿瘤的危险因素可能为第一肿瘤治疗史、吸烟史或特殊接触史(油漆、重金属铬、电子产品)。

Objective：To discuss the clinical characteristics and pathogenesis and risk factors of hematological malignancies associated with secondary primary malignancy.Methods：Collected the clinical data of 33 patients with more than two kinds of malignancy （one of which is hematological malignancy） from January 2013 to April 2017 in Department of Hematology,The First Affiliated Hospital of xi＇anJiaotong University,and analyzed which retrospectively.Results：Among 33 cases,23 were male,10 were female,6 cases were synchronous malignancies while 27 cases were metachronous.8 cases were double hematological malignancies,10 cases were therapy-related acute myeloid leukemia,2 cases were triple tumors,5 cases died in the hospital （course were 7~12 month）.Conclusion：Multiple primary tumors were more common in the patients with double primary tumors and metachronous malignancy.The median age of the SPM was relatively elder.The exact etiology and pathogenesis of SPM is not clear.These patients often have complex chromosome karyotype and poor prognosis.Risk factors for the occurrence of SPM may be the first cancer treatment history,smoking history or special contact history （paint,heavy metal chromium,electronic products）.