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随着乳腺癌生存率的提高，发生第二原发恶性肿瘤成为严重的健康问题。 2019年3月19日，日本临床肿瘤学会官方期刊《国际临床肿瘤杂志》在线发表复旦大学附属肿瘤医院魏金丽、江一舟、邵志敏等学者的研究报告，通过大数据分析探讨了第二原发恶性肿瘤患者的生存率，并且评估化疗对不同部位癌症风险的影响。 该研究通过美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）数据库，计算2000～2014年38897例乳腺癌存活者第二原发恶性肿瘤的标准化发病率。通过生存曲线法，分析总生存和癌症相关生存。随后，根据化疗与否进一步进行分层亚组分析。 结果，乳腺癌患者与标准化人群相比，所有部位第二原发癌总风险高15%（标准化发病率：1.15，95%置信区间：1.14～1.16）。单纯乳腺癌患者与两种原发癌患者相比，总生存率和癌症相关生存率显著较高（所有P<0.001）。 化疗与否相比，所有部位癌症发病率较高，除了：
乳腺癌患者化疗后，继发急性粒细胞白血病的风险，随着年龄和潜伏时间而变化。 因此，该研究结果表明，女性乳腺癌患者第二原发恶性肿瘤发生率较高，且与生存结局较差相关，应该对化疗获益与第二原发恶性肿瘤风险进行利弊权衡。 Int J Clin Oncol. 2019 Mar 19. [Epub ahead of print] Survival and chemotherapy-related risk of second primary malignancy in breast cancer patients: a SEER-based study. Wei JL, Jiang YZ, Shao ZM. Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China. BACKGROUND: With the improvement in the survival of breast cancer, developing second primary malignancy becomes a serious health issue. The aim of this study was to explore the survival of breast cancer patients with second primary malignancy, and to evaluate the impact of chemotherapy on the risk of different cancer sites. METHOD: Obtaining data from the Surveillance, Epidemiology, and End Results database, we calculated the standardized incidence ratio (SIR) for second primary malignancy in breast cancer survivors between 2000 and 2014. Overall survival and cancer-specific survival were analyzed with Kaplan-Meier method. Then, we further conducted stratified sub-analyses according to chemotherapy. RESULTS: The overall risk of second primary cancer for all sites was significantly elevated in breast cancer patients (SIR=1.15, 95% CI 1.14-1.16). Overall survival and cancer-specific survival of the patients with breast cancer only were significantly better than the patients with multiple primary cancers (both P<0.001). Chemotherapy was associated with increased incidences for all sites, except lymphoma, myeloma, and chronic lymphocytic leukemia (SIR=0.80, 95% CI 0.72-0.88; SIR=0.85, 95% CI 0.71-1.01; SIR=0.57, 95% CI 0.43-0.74, respectively). The risk for developing second acute myeloid leukemia after chemotherapy in breast cancer patients varied with age and latency. CONCLUSION: Female breast cancer patients showed higher incidence of second primary malignancy, which was associated with poorer prognosis. Chemotherapy benefits should be weighed against the risks of second primary malignancy. KEYWORDS: Breast cancer; Chemotherapy; Second primary malignancy; Survival PMID: 30888527 DOI: 10.1007/s10147-019-01430-0 |
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