影响淋巴瘤患者生存的第二原发肿瘤特点分析

Analysis of the characteristics of second primary malignancy affecting the survival of lymphoma patients

目的分析影响淋巴瘤患者生存的第二原发肿瘤特点,探讨淋巴瘤患者死于第二原发肿瘤的影响因素。方法收集1173例已经发生死亡并且死亡原因已知淋巴瘤患者的病历资料和相关死亡信息,分析淋巴瘤患者的根本死因和死于第二原发肿瘤患者的特点,采用Cox回归模型分析淋巴瘤患者死于第二原发肿瘤的影响因素。结果1173例淋巴瘤患者中,死于淋巴瘤原发病935例(79.7%),死于第二原发肿瘤94例(8.0%),死于其他各类疾病144例(12.3%)。在生存时间超过5年的217例淋巴瘤患者中,根本死因为第二原发肿瘤38例(17.5%)。在生存时间超过10年的60例淋巴瘤患者中,根本死因为第二原发肿瘤17例(28.3%)。94例死于第二原发肿瘤的患者中,死于肺癌31例,胃癌15例,肝癌13例,胰腺癌9例,结直肠癌6例,第二原发淋巴瘤6例,其他类型肿瘤14例。单因素Cox回归分析显示,患者确诊时的年龄、一线治疗效果和是否进行胸部或纵隔区放疗与淋巴瘤患者死于第二原发肿瘤有关(均P<0.05)。多因素Cox回归分析显示,一线治疗效果(P=0.030)和是否进行胸部或纵隔区放疗(P=0.039)是淋巴瘤患者死于第二原发肿瘤的独立影响因素。结论第二原发肿瘤是影响淋巴瘤患者生存的重要因素,并且随着时间的延长,死于第二原发肿瘤的风险显著增加。一线治疗的效果和接受胸部或纵隔区放疗是淋巴瘤患者死于第二原发肿瘤的独立影响因素。

Objective To analyze the characteristics of the second primary tumor affecting the survival of patients with lymphoma,and to explore the risk factors of death from the second primary tumor.Methods The medical records and related death information of 1173 lymphoma patients who had already died with known causes were collected.The basic causes of death and the characteristics of patients who died of the second primary tumor were analyzed.Cox regression model was used to analyze the risk factors of lymphoma patients who died of the second primary tumor.Results Among the 1173 patients who had died,94(8.0%)died of the second primary tumor,935(79.7%)died of the primary lymphoma and 144(12.3%)died of other diseases.The second primary tumor accounted for 17.5%(38/217)of all causes of death in patients with the survival period of more than 5 years,and the second primary tumor accounted for 28.3%(17/60)of all causes of death in patients with the survival period of more than 10 years.Among 94 cases who died of second primary tumors,31 died of lung cancer,15 died of gastric cancer,13 died of liver cancer,9 died of pancreatic cancer,6 died of colorectal cancer,6 died of second primary lymphoma and 14 died of other types of tumors.Univariate Cox regression analysis showed that age,first-line treatment effect,and chest or mediastinal radiotherapy were associated with the death from second primary tumors for lymphoma patients(all P<0.05).Multivariate Cox regression analysis showed that the effect of first-line treatment(P=0.030)and the chest or mediastinal radiotherapy(P=0.039)were independent factors for the death of lymphoma patients from the second primary tumor.Conclusions The second primary tumor is an important factor affecting the survival of lymphoma patients,and the risk of death from second primary tumors increases significantly over time.The effect of first-line treatment and radiotherapy in the chest or mediastinum are independent factors for the death of lymphoma patients from the second primary tumor.