Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients.
Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients.
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DOI：
10.1093/jnci/djaa194
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发表时间：
2021-06-01
期刊：
影响因子：
--
通讯作者：
van Leeuwen FE
中科院分区：
文献类型：
--
作者：
de Vries S;Schaapveld M;Janus CPM;Daniëls LA;Petersen EJ;van der Maazen RWM;Zijlstra JM;Beijert M;Nijziel MR;Verschueren KMS;Kremer LCM;van Eggermond AM;Lugtenburg PJ;Krol ADG;Roesink JM;Plattel WJ;van Spronsen DJ;van Imhoff GW;de Boer JP;Aleman BMP;van Leeuwen FE
很少有研究探讨治疗相关的发病率对霍奇金淋巴瘤（HL）患者的长期、病因特异性死亡率的影响。该多中心队列纳入了4919例HL患者，这些患者在1965年至2000年期间在51岁之前接受治疗，中位随访时间为20.2年。计算了标准化死亡率、每10000人年的绝对超额死亡率（AEM）以及各阶段和主要治疗的病因特异性累积死亡率，并考虑了竞争风险。HL患者因HL以外原因死亡的风险高5.1倍（AEM =每10000人-年123例额外死亡）。在40年存活者中，这种风险仍然增加（标准化死亡率= 5.2，95%置信区间[CI] = 4.2 - 6.5，AEM = 619）。在54岁时，HL幸存者因HL以外的原因发生的累积死亡率（20.0%）与一般人群中71岁的个体相似。虽然HL死亡率在日历期间统计学上显着下降（P < .001），但实体瘤死亡率在最近的治疗时代没有变化。1989-2000年接受治疗的患者25年心血管疾病死亡率低于1965-1976年接受治疗的患者（4.3% vs 5.7%;亚分布风险比= 0.65，95% CI = 0.46 - 0.93）。感染性疾病死亡率不仅增加脾切除术后，而且脾照射后（风险比= 2.81，95%CI = 1.55至5.07）。对于I-II期，仅化疗（CT）的主要治疗与统计学显著较高的HL死亡率相关（P <0.001，CT与放疗[RT]; CT与RT+CT相比P = 0.04），但HL以外原因的30年死亡率较低（15.8%，95% CI = 9.7%至23.3%）与单独RT（36.9%，95% CI = 34.0%至39.8%，P = 0.001）和RT和CT联合（29.8%，95% CI = 26.8%至32.9%，P = 0.02）相比。与一般人群相比，HL幸存者的预期寿命大幅缩短。进行初次CT的患者的最佳选择至关重要，权衡HL复发和长期毒性的风险。
Few studies have examined the impact of treatment-related morbidity on long-term, cause-specific mortality in Hodgkin lymphoma (HL) patients. 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. HL patients experienced a 5.1-fold (AEM = 123 excess deaths per 10 000 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). 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.
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影响因子：
50.5
作者：
Eichenauer, D. A.;Aleman, B. M. P.;Ladetto, M.
通讯作者：
Ladetto, M.
影响因子：
45.3
作者：
Swerdlow, AJ;Schoemaker, MJ;Linch, DC
通讯作者：
Linch, DC
影响因子：
2.6
作者：
Myrehaug, Sten;Pintilie, Melania;Hodgson, David C.
通讯作者：
Hodgson, David C.
影响因子：
37.8
作者：
Henson KE;Reulen RC;Winter DL;Bright CJ;Fidler MM;Frobisher C;Guha J;Wong KF;Kelly J;Edgar AB;McCabe MG;Whelan J;Cutter DJ;Darby SC;Hawkins MM
通讯作者：
Hawkins MM
影响因子：
45.3
作者：
Aleman, BMP;van den Belt-Dusebout, AW;van Leeuwen, FE
通讯作者：
van Leeuwen, FE