Risk of hematologic malignancies after breast ductal carcinoma in situ treatment with ionizing radiation

作者全名："Wang, Kang; Li, Zhuyue; Chen, Xingxing; Zhang, Jianjun; Xiong, Yongfu; Zhong, Guochao; Shi, Yang; Li, Qing; Zhang, Xiang; Li, Hongyuan; Xiang, Tingxiu; Foukakis, Theodoros; Radivoyevitch, Tomas; Ren, Guosheng"

作者地址："[Wang, Kang; Li, Qing; Zhang, Xiang; Li, Hongyuan; Ren, Guosheng] Chongqing Med Univ, Dept Endocrine & Breast Surg, Affiliated Hosp 1, Chongqing, Peoples R China; [Wang, Kang; Xiang, Tingxiu; Ren, Guosheng] Chongqing Med Univ, Key Lab Mol Oncol & Epigenet, Affiliated Hosp 1, Chongqing, Peoples R China; [Wang, Kang; Foukakis, Theodoros] Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden; [Li, Zhuyue] Sichuan Univ, West China Sch Nursing, West China Hosp, Chengdu, Peoples R China; [Chen, Xingxing] Fudan Univ, Shanghai Med Coll, Dept Oncol, Shanghai, Peoples R China; [Chen, Xingxing] Fudan Univ, Dept Radiat Oncol, Shanghai Canc Ctr, Shanghai, Peoples R China; [Zhang, Jianjun] Indiana Univ, Fairbanks Sch Publ Hlth, Dept Epidemiol, 1050 Wishard Blvd RG5118, Indianapolis, IN USA; [Zhang, Jianjun] Indiana Univ, Melvin & Bren Simon Comprehens Canc Ctr, 1050 Wishard Blvd RG5118, Indianapolis, IN USA; [Xiong, Yongfu] North Sichuan Med Coll, Affiliated Hosp, Dept Hepatobiliary Surg 1, Nanchong, Peoples R China; [Zhong, Guochao] Chongqing Med Univ, Dept Hepatobiliary Surg, Affiliated Hosp 2, Chongqing, Peoples R China; [Shi, Yang] Augusta Univ, Dept Populat Hlth Sci, Med Coll Georgia, Div Biostat & Data Sci, Augusta, GA USA; [Foukakis, Theodoros] Karolinska Univ Hosp, Breast Ctr, Theme Canc, Stockholm, Sweden; [Radivoyevitch, Tomas] Cleveland Clin, Lerner Res Inst, Quantitat Hlth Sci, Cleveland, OH 44106 USA"

通信作者："Ren, GS (corresponding author), Chongqing Med Univ, Dept Endocrine & Breast Surg, Affiliated Hosp 1, Chongqing, Peoples R China.; Ren, GS (corresponding author), Chongqing Med Univ, Key Lab Mol Oncol & Epigenet, Affiliated Hosp 1, Chongqing, Peoples R China.; Foukakis, T (corresponding author), Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.; Foukakis, T (corresponding author), Karolinska Univ Hosp, Breast Ctr, Theme Canc, Stockholm, Sweden.; Radivoyevitch, T (corresponding author), Cleveland Clin, Lerner Res Inst, Quantitat Hlth Sci, Cleveland, OH 44106 USA."

来源：NPJ BREAST CANCER

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000626056100001

JCR分区：Q1

影响因子：5.9

年份：2021

卷号：7

期号：1

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结束页：　

文献类型：Article

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摘要："The increased incidence of secondary hematologic malignancies (SHM) is a well-known, potentially fatal, complication after cancer treatment. It is unknown if patients with ductal carcinoma in situ (DCIS) of the breast treated with external beam radiotherapy (RT) and who survive long-term have increased risks of secondary hematologic malignancies (SHM), especially for low/intermediate-risk subsets with limited benefits from RT. DCIS patients in Surveillance, Epidemiology, and End Results (SEER) registries (1975-2016) were identified. Relative risks (RR), hazard ratio (HR), and standardized incidence ratios (SIR) were calculated to assess the SHM risk and subsequent survival times. SHM development, defined as a nonsynchronous SHM occurring >= 1 year after DCIS diagnosis, was our primary endpoint. Of 184,363 eligible patients with DCIS, 77,927 (42.3%) in the RT group, and 106,436 (57.7%) in the non-RT group, 1289 developed SHMs a median of 6.4 years (interquartile range, 3.5 to 10.3 years) after their DCIS diagnosis. Compared with DCIS patients in the non-RT group, RT was associated with increased early risk of developing acute lymphoblastic leukemia (ALL; hazard ratio, 3.15; 95% CI, 1.21 to 8.17; P = 0.02), and a delayed risk of non-Hodgkin lymphoma (NHL; hazard ratio, 1.33; 95% CI, 1.09 to 1.62; P < 0.001). This increased risk of ALL and NHL after RT was also observed in subgroup analyses restricted to low/intermediate-risk DCIS. In summary, our data suggest that RT after breast conserving surgery for DCIS patients should be cautiously tailored, especially for low and intermediate-risk patients. Long-term SHM surveillance after DCIS diagnosis is warranted."

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