Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Baseline Characteristics
2.2. Second Primary Malignancies
2.3. Association of SPMs with the Therapy of Myeloid Neoplasms
3. Discussion
4. Materials and Methods
4.1. Data Source
4.2. Study Population
4.3. Ethics
4.4. Statistical Methods
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | APL | Non-APL | Non-APL AML | ||
---|---|---|---|---|---|
Total number of records | 4520 | 6,695,986 | 51,501 | ||
First cancer and primary by WHO rules | 4019 | 5,677,898 | 38,495 | ||
First primary malignancy only | 3774 | 4,898,363 | 35,292 | ||
Mean age at diagnosis in years (SD) | 45.4 (19.3) | 63.1 (15.7) | 61.1 (21.9) | ||
Sex | |||||
Female | 1.855 (49.2) | 2,395,182 (48.9) | 16,145 (45.7) | ||
Male | 1.919 (50.8) | 2,503,181 (51.1) | 19,147 (54.3) | ||
Ethnicity | |||||
Hispanic (all races) | 908 (24.1) | 511,927 (10.5) | 4475 (12.7) | ||
Non-Hispanic (white) | 766 (20.3) | 3,451,992 (70.5) | 24,540 (69.5) | ||
Non-Hispanic (other) | 2100 (55.6) | 934,444 (19.0) | 6277 (17.8) | ||
Median follow-up time in years (range) | 4.8 (0.1–16.9) | 3.1 (0.1–16.9) | 0.5 (0.1–16.9) | ||
Second primary malignancy | 116 | 392,016 | 755 | ||
Mean age at diagnosis of the first malignancy in years (SD) | 53.9 (15.7) | 66.3 (11.8) | 61.2 (16.6) | ||
Mean age at diagnosis of the SPM in years (SD) | 59.0 (14.5) | 70.1 (11.7) | 63.8 (15.7) | ||
Sex | |||||
Female | 56 (48.3) | 155,494 (39.7) | 311 (40.1) | ||
Male | 60 (51.7) | 236,522 (60.3) | 464 (59.9) | ||
Ethnicity | |||||
Hispanic (all races) | 14 (12.1) | 27,787 (7.1) | 68 (8.8) | ||
Non-Hispanic (white) | 78 (67.2) | 304,360 (77.7) | 604 (77.9) | ||
* Non-Hispanic (other) | 24 (20.7) | 59,869 (15.2) | 103 (13.3) | ||
Median latency time in years (range) | 4 (0.1–14) | 3 (0–16) | 1 (0–16) | ||
Median follow-up time in years (range) | 7.8 (0.2–16.9) | 6.3 (0.1–16.9) | 2.9 (0.1–16.7) |
Baseline Characteristics | APL/SPM | APL/only | p * | Non-APL/SPM | p * | Non-APL AML/SPM | p# | |
---|---|---|---|---|---|---|---|---|
Frequency of SPM | 2.9% | --- | --- | 6.9% | <0.001 | 2.0% | 0.193 | |
Age | ||||||||
<40 years | 18 (15.5) | 1486 (39.4) | <0.001 | 7667 (2.0) | <0.001 | 70 (9.0) | <0.001 | |
≥40 years | 98 (84.5) | 2288 (60.6) | 384,349 (98.0) | 705 (91.0) | ||||
Sex | ||||||||
Female | 56 (48.3) | 1.855 (49.2) | 0.942 | 155,494 (39.7) | 0.058 | 311 (40.1) | 0.096 | |
Male | 60 (51.7) | 1.919 (50.8) | 236,522 (60.3) | 464 (59.9) | ||||
Ethnicity | ||||||||
Hispanic | 14 (12.1) | 908 (24.1) | 0.001 | 27,787 (7.1) | <0.001 | 68 (8.8) | <0.001 | |
Non-Hispanic (white) | 78 (67.2) | 2100 (55.6) | 304,360 (77.7) | 604 (77.9) | ||||
* Non-Hispanic (other) | 24 (20.7) | 766 (20.3) | 59,869 (15.2) | 103 (13.3) | ||||
Median follow-up time in years (range) | 7.8 (0.2–16.9) | 4.8 (0.1–16.9) | <0.001 | 6.3 (0.1–16.9) | 0.001 | 2.9 (0.1–16.7) | <0.001 |
Risk Factors | APL/only n (%) | APL/SPM n (%) | HR (CI95%) | p# | |
---|---|---|---|---|---|
Age | |||||
<40 years | 18 (15.5) | 1486 (39.4) | --- | ||
≥40 years | 98 (84.5) | 2288 (60.6) | 5.1 (3.1–8.4) | <0.001 | |
Race/ethnicity | |||||
Hispanic (all races) | 14 (12.1) | 908 (24.1) | --- | 0.020 | |
Non-Hispanic white | 78 (67.2) | 2100 (55.6) | 2.3 (1.3–4.0) | 0.005 | |
* Non-Hispanic (other) | 24 (20.7) | 766 (20.3) | 2.0 (1.0–3.8) | 0.041 |
Second Primary Malignancy | APL/SPM n (%) | Non-APL/SPM n (%) | RR (CI95%) | p * |
---|---|---|---|---|
Overall | 116 | 392,016 | ||
Liver | 7 (6.0) | 5719 (1.5) | 4.6 (2.1–9.9) | <0.001 |
Salivary gland | 4 (3.4) | 1542 (0.4) | 9.8 (3.6–26.5) | <0.001 |
Soft tissue | 4 (3.4) | 3241 (0.8) | 4. 7 (1.7–12.6) | 0.003 |
In men | 60 | 236,522 | ||
Liver | 5 (8.3) | 4325 (1.8) | 7.6 (2.9–19.6) | <0.001 |
Salivary gland | 2 (3.3) | 937 (0.4) | 14.0 (3.3–58.6) | <0.001 |
Soft tissue, including heart | 2 (3.3) | 1911 (0.8) | 6.9 (1.6–28.7) | 0.008 |
Prostate | 22 (36.7) | 39,068 (16.5) | 3.7 (2.1–6.4) | <0.001 |
In women | 56 | 155,494 | ||
Liver | 2 (3.6) | 1394 (0.9) | 4.4 (1.1–17.9) | 0.041 |
Salivary gland | 2 (3.6) | 605 (0.4) | 10.0 (2.4–41.2) | 0.001 |
Soft tissue | 2 (3.6) | 1330 (0.9) | 4.571 (1.1–18.8) | 0.035 |
Female breast | 12 (21.4) | 24,270 (15.6) | 2. 5 (0.9–6.3) | 0.057 |
Cancer | Incidence/100.000 (2000–2016) | |||
---|---|---|---|---|
All Registries SEER 18 * | All APL * | p | ||
Liver | ||||
Sex | Female | 3.8 | 6.2 | 0.016 |
Male | 10.9 | 14.9 | 0.013 | |
Age | <40 | 0.3 | 0.0 | 0.317 |
≥40 | 16.1 | 17.3 | 0.511 | |
Salivary Gland | ||||
Sex | Female | 1.1 | 6.2 | <0.001 |
Male | 1.5 | 8.9 | <0.001 | |
Age | <40 | 0.3 | 7.8 | <0.001 |
≥40 | 2.6 | 7.4 | <0.001 | |
Soft Tissue | ||||
Sex | Female | 2.9 | 9.2 | <0.001 |
Male | 3.7 | 5.9 | 0.025 | |
Age | <40 | 1.4 | 7.8 | <0.001 |
≥40 | 5.7 | 7.4 | 0.137 |
Cancer Sites in SPM | Observed | Expected | SIR | CI95% | Excess Risk | |
---|---|---|---|---|---|---|
APL/SPM | ||||||
Salivary gland | 4 | 0.31 | 12.89 | (3.51–33.01) | 2.02 | |
Liver | 6 | 2.07 | 2.90 | (1.07–6.32) | 2.16 | |
Soft tissue | 4 | 0.77 | 5.18 | (1.41–13.25) | 1.77 | |
Non-APL/SPM | ||||||
Salivary gland | 1775 | 1191.23 | 1.49 | (1.42–1.56) | 0.2 | |
Liver | 6254 | 6710.05 | 0.93 | (0.91–0.96) | −0.16 | |
Soft tissue | 4025 | 2440.49 | 1.65 | (1.6–1.7) | 0.56 |
Second Primary Malignancy Site | APL/SPM (n = 116) n (%) | Non-APL AML (n = 775) n (%) | RR (CI95%) | p * |
---|---|---|---|---|
Overall | ||||
Liver | 7 (6.0) | 4 (0.5) | 5.437 (2.528–11.697) | <0.001 |
Salivary gland | 4 (3.4) | 3 (0.4) | 4.883 (1.798–13.262) | 0.002 |
Soft tissue | 4 (3.4) | 6 (0.8) | 3.418 (1.258–9.283) | 0.016 |
In men | 60 | 464 | ||
Liver | 5 (8.3) | 4 (0.9) | 7.682 (2.974–19.845) | <0.001 |
Salivary gland | 2 (3.3) | 2 (0.4) | 6.914 (1.650–28.974) | 0.008 |
Soft tissue | 2 (3.3) | 3 (0.6) | 5.531 (1.320–23.180) | 0.019 |
Prostate | 22 (36.7) | 83 (17.9) | 2.897 (1.665–5.042) | <0.001 |
In women | 56 | 311 | ||
Liver | 2 (3.6) | 0 (0.0) | 7.140 (1.737–29.343) | 0.006 |
Salivary gland | 2 (3.6) | 1 (0.32) | 4.760 (1.158–19.562) | 0.030 |
Soft tissue | 2 (3.6) | 3 (1.0) | 2.856 (0.695–11.737) | 0.146 |
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Lenzi, L.; Lee-Jones, L.; Mostofa, M.A.; de Andrade, D.P.; Ribeiro, R.C.; Figueiredo, B.C. Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study. Cancers 2020, 12, 3610. https://doi.org/10.3390/cancers12123610
Lenzi L, Lee-Jones L, Mostofa MA, de Andrade DP, Ribeiro RC, Figueiredo BC. Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study. Cancers. 2020; 12(12):3610. https://doi.org/10.3390/cancers12123610
Chicago/Turabian StyleLenzi, Luana, Lisa Lee-Jones, Maruf A. Mostofa, Diancarlos P. de Andrade, Raul C. Ribeiro, and Bonald C. Figueiredo. 2020. "Second Primary Malignancy after Acute Promyelocytic Leukemia: A Population-Based Study" Cancers 12, no. 12: 3610. https://doi.org/10.3390/cancers12123610