The relationship among primary anatomic subsite and risk and distribution of second malignant neoplasms in patients with stage I/II diffuse large B-cell lymphoma: An analysis of the surveillance, epidemiology, and end results database

Xuejiao Yin; Aoshuang Xu; Zhenli Huang; Fengjuan Fan; Yajun Wang; Lei Chen; Guohui Cui; Yu Hu; Chunyan Sun

doi:10.1016/j.tranon.2021.101106

The relationship among primary anatomic subsite and risk and distribution of second malignant neoplasms in patients with stage I/II diffuse large B-cell lymphoma: An analysis of the surveillance, epidemiology, and end results database

Transl Oncol. 2021 Jul;14(7):101106. doi: 10.1016/j.tranon.2021.101106. Epub 2021 Apr 28.

Authors

Xuejiao Yin¹, Aoshuang Xu¹, Zhenli Huang¹, Fengjuan Fan¹, Yajun Wang¹, Lei Chen¹, Guohui Cui¹, Yu Hu², Chunyan Sun²

Affiliations

¹ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Background: Recent studies have reported that diffuse large B-cell lymphoma (DLBCL) involving different primary extranodal sites have distinct clinicopathological characteristics and prognosis. However, the risk of secondary malignant neoplasms (SMNs) in DLBCL survivors with different primary extranodal sites are unknown.

Methods: A total of 40,714 patients diagnosed with stage I/II DLBCL were included from the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2015.The standardized incidence ratio (SIR) and absolute excess risk (AER) were used to assess the risk of SMNs.

Results: The results show that the risk of SMN was significantly higher in extranodal DLBCL than in the US general population (SIR, 1.18; 95% CI, 1.11-1.26), and the risk of developing SMN remains significantly elevated with increased latency. Moreover, there were multiple site-specific risk patterns. There was a 22%, 44%, 66%, 123% and 151% increased risk of SMN 10 years after primary gastrointestinal tract, head/neck, skeletal, lung and liver/pancreas DLBCL diagnosis, respectively. There was a significant decrease risk of SMN with increasing age at diagnosis for primary gastrointestinal tract and skeletal DLBCL. In addition, DLBCL patients with primary sites in the gastrointestinal tract, thyroid and liver/pancreas had the highest incidences of secondary stomach cancer, second thyroid cancer, and second hepatobiliary cancer, respectively, which indicated that the initial site of DLBCL may predict the type of SMN.

Conclusions: The strategies for cancer surveillance after extranodal DLBCL diagnosis may need to be individualized according to the subsite of extranodal DLBCL.

Keywords: AER: absolute excess risk; Abbreviations; CI: confidence interval; DLBCL; DLBCL: diffuse large B-cell lymphoma; Epidemiology and end results database; GI tract: gastrointestinal tract; HR: hazard ratio; O/E: observed-to-expected; OS: overall survival; Primary extranodal sites; Prognosis; SEER: surveillance; SIR: standardized incidence ratio; SMNs: secondary malignant neoplasms; Second malignant neoplasms; Standardized incidence ratio.