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Development of second primary malignancy in patients with non-Hodgkin lymphoma: a nationwide population-based study

Journal of Cancer Research and Clinical Oncology volume 141, pages 1995–2004 (2015)Cite this article

Abstract

Background

With the improved survival of non-Hodgkin lymphoma (NHL) patients, development of second primary malignancy (SPM) has become an increasingly important issue in these long-term survivors.

Methods

We conducted a retrospective study to analyze NHL patients diagnosed between January 1997 and December 2010 in Taiwan. Standardized incidence ratios (SIRs) were applied to compare the risk of SPMs in NHL patients and the general population. Multivariate analysis was performed to determine the independent predictors of SPM.

Result

NHL patients have a significantly greater risk of developing SPM [SIR 1.43; 95 % confidence interval (CI) 1.32–1.55; p < 0.001). A significantly high SIR was noted for leukemia, myeloma, and neoplasms of the bone and soft tissue, thyroid, central nervous system, skin, stomach, head and neck, liver and biliary tract, and the lungs and mediastinum. Multivariate analysis revealed that age ≥60 years [hazard ratios (HR) 2.04], being male (HR 1.22), comorbidities of chronic obstructive pulmonary disease (HR 1.34), liver cirrhosis (HR 1.50), hepatitis C infection (HR 1.94) and therapy containing radiotherapy (HR 1.38) were the significant predictors for SPM occurrence. The median follow-up time and survival time were 3.37 and 9.45 years, respectively.

Conclusion

This Taiwanese population-based study provides updated data about the risk of SPM in NHL patients, demonstrating an approximately 1.5 time greater risk of SPM compared to the general population. A high risk of SPM for myeloma and hepatocellular carcinoma is unique to Asian patients.

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Acknowledgments

This study is supported by a Grant from Taipei Veterans General Hospital (V104E10-001, V104B-023, and V104C-182), Taiwan Clinical Oncology Research Foundation, and partially supported by Chong Hin Loon Memorial Cancer and Biotherapy Research Cancer, National Yang-Ming University. The study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health or National Health Research Institutes. Miss Chiu-Mei Yeh contributed significantly to the calculations and interpretations of statistical analyses in this study.

Conflict of interest

The authors declare no conflict of interest.

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Author notes

    Affiliations

    1. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Shipai Road, Sec. 2, Taipei, 11217, Taiwan

      Sheng-Hsuan Chien, Chia-Jen Liu, Jyh-Pyng Gau & Cheng-Hwai Tzeng

    2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

      Chia-Jen Liu, Ying-Chung Hong, Chung-Jen Teng, Yu-Wen Hu, Tzeon-Jye Chiou, Jyh-Pyng Gau & Cheng-Hwai Tzeng

    3. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

      Chia-Jen Liu & Chiu-Mei Yeh

    4. Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

      Ying-Chung Hong

    5. Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

      Chung-Jen Teng

    6. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

      Yu-Wen Hu

    7. Department of Hematology and Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan

      Fan-Chen Ku

    8. Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

      Tzeon-Jye Chiou

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    1. Sheng-Hsuan Chien
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    Correspondence to Jyh-Pyng Gau.

    Additional information

    Sheng-Hsuan Chien and Chia-Jen Liu contribute equally to this work.

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    Cite this article

    Chien, SH., Liu, CJ., Hong, YC. et al. Development of second primary malignancy in patients with non-Hodgkin lymphoma: a nationwide population-based study. J Cancer Res Clin Oncol 141, 1995–2004 (2015). https://doi.org/10.1007/s00432-015-1979-1

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    • DOI: https://doi.org/10.1007/s00432-015-1979-1

    Keywords

    • Cancer risk
    • Epidemiology
    • Non-Hodgkin lymphoma
    • Population study
    • Second malignancy