Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients

被引：68

作者：

de Vries, Simone ^{[1
]}

Schaapveld, Michael ^{[1
,2
]}

Janus, Cecile P. M. ^{[3
]}

Daniels, Laurien A. ^{[4
]}

Petersen, Eefke J. ^{[5
]}

van der Maazen, Richard W. M. ^{[6
]}

Zijlstra, Josee M. ^{[7
]}

Beijert, Max ^{[8
]}

Nijziel, Marten R. ^{[9
]}

Verschueren, Karijn M. S. ^{[10
]}

Kremer, Leontien C. M. ^{[11
]}

van Eggermond, Anna M. ^{[1
]}

Lugtenburg, Pieternella J. ^{[12
]}

Krol, Augustinus D. G. ^{[4
]}

Roesink, Judith M. ^{[13
]}

Plattel, Wouter J. ^{[14
]}

van Spronsen, Dick Johan ^{[15
]}

van Imhoff, Gustaaf W. ^{[14
]}

de Boer, Jan Paul ^{[16
]}

Aleman, Berthe M. P. ^{[17
]}

van Leeuwen, Flora E. ^{[1
]}

机构：

[1] Netherlands Canc Inst, Dept Epidemiol, Plesmanlaan 121, NL-1066 CX Amsterdam, Netherlands

[2] Netherlands Comprehens Canc Org IKNL, Utrecht, Netherlands

[3] Erasmus MC, Dept Radiat Oncol, Canc Inst, Rotterdam, Netherlands

[4] Leiden Univ, Dept Radiat Oncol, Med Ctr, Leiden, Netherlands

[5] Univ Med Ctr Utrecht, Dept Hematol, Utrecht, Netherlands

[6] Radboud Univ Nijmegen, Dept Radiat Oncol, Med Ctr, Nijmegen, Netherlands

[7] Univ Amsterdam, Vrije Univ, Canc Ctr Amsterdam, Dept Hematol,Med Ctr, Amsterdam, Netherlands

[8] Univ Med Ctr Groningen, Dept Radiat Oncol, Groningen, Netherlands

[9] Catharina Hosp, Dept Hematol, Eindhoven, Netherlands

[10] Inst Verbeeten, Dept Radiat Oncol, Tilburg, Netherlands

[11] Princess Maxima Ctr Pediat Oncol, Late Effects Res Grp, Utrecht, Netherlands

[12] Erasmus MC, Dept Hematol, Canc Inst, Rotterdam, Netherlands

[13] Univ Med Ctr Utrecht, Dept Radiat Oncol, Utrecht, Netherlands

[14] Univ Med Ctr Groningen, Dept Hematol, Groningen, Netherlands

[15] Radboud Univ Nijmegen, Dept Hematol, Med Ctr, Nijmegen, Netherlands

[16] Netherlands Canc Inst, Dept Med Oncol, Amsterdam, Netherlands

[17] Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands

来源：

JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE | 2021年 / 113卷 / 06期

关键词：

2ND CANCER-RISK; RADIATION-THERAPY; CHILDHOOD-CANCER; STOMACH-CANCER; LUNG-CANCER; DISEASE; CHEMOTHERAPY; SURVIVORS; CARDIOTOXICITY; RADIOTHERAPY;

D O I：

10.1093/jnci/djaa194

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Few studies have examined the impact of treatment-related morbidity on long-term, cause-specific mortality in Hodgkin lymphoma (HL) patients. Methods: This multicenter cohort included 4919 HL patients, treated before age 51 years between 1965 and 2000, with a median follow-up of 20.2 years. Standardized mortality ratios, absolute excess mortality (AEM) per 10 000 person-years, and cause-specific cumulative mortality by stage and primary treatment, accounting for competing risks, were calculated. Results: HL patients experienced a 5.1-fold (AEM = 123 excess deaths per 10000 person-years) higher risk of death due to causes other than HL. This risk remained increased in 40-year survivors (standardized mortality ratio = 5.2, 95% confidence interval [CI] = 4.2 to 6.5, AEM = 619). At age 54 years, HL survivors experienced similar cumulative mortality (20.0%) from causes other than HL to 71-year-old individuals from the general population. Whereas HL mortality statistically significantly decreased over the calendar period (P < .001), solid tumor mortality did not change in the most recent treatment era. Patients treated in 1989-2000 had lower 25-year cardiovascular disease mortality than patients treated in 1965-1976 (4.3% vs 5.7%; subdistribution hazard ratio = 0.65, 95% CI = 0.46 to 0.93). Infectious disease mortality was not only increased after splenectomy but also after spleen irradiation (hazard ratio = 2.81, 95% CI = 1.55 to 5.07). For stage I-II, primary treatment with chemotherapy (CT) alone was associated with statistically significantly higher HL mortality (P < .001 for CT vs radiotherapy [RT]; P = .04 for CT vs RT+CT) but lower 30-year mortality from causes other than HL (15.8%, 95% CI = 9.7% to 23.3%) compared with RT alone (36.9%, 95% CI = 34.0% to 39.8%, P = .001) and RT and CT combined (29.8%, 95% CI = 26.8% to 32.9%, P = .02). Conclusions: Compared with the general population, HL survivors have a substantially reduced life expectancy. Optimal selection of patients for primary CT is crucial, weighing risks of HL relapse and long-term toxicity.

引用

页码：760 / 769

页数：10

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