胃肠道弥漫性大B细胞淋巴瘤第二原发性恶性肿瘤的风险及预后分析  

Risk analysis of gastrointestinal diffuse large B-cell lymphoma of tract as a second primary malignancy

作　　者：王鸿彬 章忆晖 王程 穆林松[3] 吕忠船[3] WANG Hongbin;ZHANG Yihui;WANG Cheng;MU Linsong;LYU Zhongchuan(School of Clinical Medicine,Shandong Second Medical University,Shandong Province,Weifang261000,China;School of Clinical Medicine,Binzhou Medical College,Shandong Province,Yantai264000,China;Department of General Surgery,Yantai Yuhuangding Hospital,Shandong Province,Yantai264000,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261000 [2]滨州医学院临床医学院,山东烟台264000 [3]山东省烟台毓璜顶医院普外科,山东烟台264000

出　　处：《中国医药导报》2024年第29期16-22,共7页China Medical Herald

基　　金：山东省医药卫生科技发展计划项目(202104010626)。

摘　　要：目的探讨胃肠道弥漫性大B细胞淋巴瘤(GI-DLBCL)发生第二原发性恶性肿瘤(SPM)的危险因素及生存分析。方法该研究使用监测、流行病学和最终结果(SEER)数据库,选择2000—2020年被诊断为GI-DLBCL的患者,提取人口统计学特征,包括诊断年龄、性别、种族、婚姻状态、序列号、原发部位、SPM部位、治疗信息、生存时间和患者结局。评估了GI-DLBCL患者在生存因素和SPM方面的风险。使用标准化发生率(SIR)估计发生SPM的相对风险。使用Kaplan-Meier法、log-rank检验、Land Mark分析和Cox回归分析评估总体生存率。结果共纳入8113例GI-DLBCL患者,其中710例(8.75%)发生SPM。单次原发性恶性肿瘤(OPM)组和SPM组在性别、种族、婚姻状态、化疗史及Ann Arbor分期比较,差异有统计学意义(P<0.05)。SPM最常见于淋巴瘤、结直肠和男性生殖系统。诊断年龄是8年随访组和8年以上随访组中患者生存率低的危险因素(P<0.05)。此外,在8年随访组中,肿瘤分期是生存率低的危险因素(P<0.05)。种族、化疗史和SPM是影响患者生存率的重要因素(P<0.05)。在8年以上随访组中,男性和SPM也是患者生存率低的独立危险因素(P<0.05)。结论GI-DLBCL患者的性别、诊断年龄、种族和化疗史与SPM的发生密切相关。此外,诊断年龄、性别、种族、化疗史、分期和SPM是GI-DLBCL患者在不同时期生存组生存率的独立预测因子。这项研究有助于制订更有效的策略和预防措施,以便对GI-DLBCL患者进行治疗后监测。Objective To investigate the risk factors for the development of second primary malignancy(SPM)in patients with gastrointestinal diffuse large B-cell lymphoma(GI-DLBCL)and to analyze survival outcomes.Methods The surveillance,epidemiology,and end results(SEER)database was utilized to identify patients diagnosed with GI-DLBCL between 2000 and 2020.Detailed demographic characteristics,including age at diagnosis,sex,race,marital status,primary site,SPM site,treatment information,survival time,and patient outcomes,were extracted.The relative risk of developing SPM was estimated using the standardized incidence ratio(SIR).Overall survival was assessed using the Kaplan-Meier method,log-rank test,LandMark analysis,and Cox regression analysis.Results A total of 8113 patients with GI-DLBCL were enrolled,and 710 cases(8.75%)developed SPM.Significant differences were found between the only primary malignancy(OPM)group and the SPM group in terms of sex,race,marital status,Ann Arbor staging,and history of chemotherapy(P<0.05).SPM was most common in the lymphatic,colorectal,and male reproductive systems.Age at diagnosis was a risk factor for lower patient survival in both the 8-year and 8+year follow-up groups(P<0.05).Additionally,tumor stage was a risk factor for lower survival in the 8-year follow-up group(P<0.05).Ethnicity,history of chemotherapy,and SPM were significant factors affecting patient survival(P<0.05).In the 8+year follow-up group,male gender and SPM were also independent risk factors for lower patient survival(P<0.05).Conclusion Sex,age at diagnosis,ethnicity,and chemotherapy history are strongly associated with the development of SPM in patients with GI-DLBCL.Furthermore,age at diagnosis,gender,ethnicity,chemotherapy history,stage,and SPM are independent predictors of survival over time for GI-DLBCL patients.These findings contribute to the development of more effective strategies and preventive measures for post-treatment monitoring in GI-DLBCL patients.

关 键 词：胃肠道 弥漫性大B细胞淋巴瘤 第二原发性恶性肿瘤 预后 

分 类 号：R735[医药卫生—肿瘤]