急性淋巴性白血病患者发生第二原发癌症的影响因素分析

Influencing factors of secondary primary cancer in patients with acute lymphoid leukemia

目的 分析急性淋巴性白血病(ALL)患者继发第二原发癌症(SPC)的影响因素。方法 使用美国国立癌症研究所“监测、流行病学和结果数据库”(Surveillance, Epidemiology and End Results database)提取数据,采用SEER*Stat program 8.4.0计算标准化发病率比(SIR)和绝对超额率(AER),并通过R 4.2.1采用Cox回归模型估计不同年龄、年代、种族、性别、是否接受化疗、放疗等因素对发生第二肿瘤的风险比(HR)以及通过Kaplan-Meier法绘制累计发病率图。结果 总计纳入22 407例病例,随访人年数为142 780.82。共计发生SPC436例,继发第二癌症的中位数时间为47.5个月。ALL患者发生SPC的风险高于普通人群(SIR=2.27;95%CI:2.07~2.50),SPC发生部位最多的为淋巴及造血系统,SIR为6.96(95%CI:5.94~8.11)。不同年代诊断的ALL患者发生SPC的风险呈上升趋势,由2000年1.98升高到2019年2.38,随着年龄增长,ALL患者发生SPC的风险逐渐降低。接受化疗能够降低发生SPC的风险(HR=0.26;95%CI:0.19~0.36),接受放疗会增加59.60%(HR=1.57;95%CI:1.23~2.00)发生SPC的风险。结论 未来对ALL患者建议采用化疗手段,减少接受放疗时受到的辐射接触,在ALL患者患病后1~5年内更进一步关注其健康状况。

Objective To analyze the influencing factors of second primary cancer(SPC) in patients with acute lymphoblastic leukemia(ALL). Methods The Surveillance, Epidemiology and End Results database of the National Cancer Institute was used to extract data, and SEER*Stat program 8.4.0 was used to calculate the standardized incidence rate ratio(SIR) and absolute excess rate(AER).In addition, Cox regression models were used to estimate the hazard ratio(HR) of different age, race, sex, chemotherapy, and radiation and other factors for secondary tumors by R 4.2.1,and Kaplan-Meier method was used to plot the cumulative incidence. Results A total of 22 407 cases were included, and the person-years of follow-up were 142 780.82.There was a total of 436 SPC cases, 32 of which developed multiple cancers.The median time of secondary cancers was 47.5 months.Patients with ALL had a higher risk of SPC than the general population(SIR=2.27;95% CI:2.07-2.50),and the most observed SPC was lymphatic and hematopoietic system, with an SIR of 6.96(95% CI:5.94-8.11).The risk of SPC in ALL patients diagnosed in different time periods showed an upward trend, from 1.98 in 2000 to 2.38 in 2019.With the increase of age, the risk of SPC in ALL patients gradually decreased.Chemotherapy reduced the risk of SPC(HR=0.26;95% CI:0.19-0.36),while radiotherapy increased the risk of SPC by 59.60%(HR=1.57;95% CI:1.23-2.00). Conclusion In the future, chemotherapy is recommended for ALL patients to reduce radiation exposure during radiotherapy, and more attention should be paid to the health status of ALL patients within 1-5 years after their onset.