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Evidence From Population-Based and Clinical Cohorts

Kathie P. Huang, MD; Martin A. Weinstock, MD, PhD; Christina A. Clarke, PhD; Alex McMillan, PhD; Richard T. Hoppe, MD; Youn H. Kim, MD

Arch Dermatol. 2007;143(1):45-50.

Objective  To assess risks for developing second malignancies in patients with mycosis fungoides or Sézary syndrome.

Design  Retrospective study of 2 cohorts.

Setting  Nine population-based US cancer registries that constitute the Surveillance, Epidemiology, and End Results Program (SEER-9), and Stanford University referral center cohort of patients with cutaneous lymphoma.

Patients  Patients with mycosis fungoides or Sézary syndrome from the SEER-9 registry diagnosed and followed up from 1984 through 2001 and from the Stanford University cohort diagnosed and followed up from 1973 through 2001.

Main Outcome Measures  Relative risk was estimated using the standardized incidence ratio (SIR). The expected cancer incidence for both cohorts was calculated using age-, sex-, race-, and calendar year–specific SEER-9 incidence rates for the general population. Nonmelanoma skin cancers were excluded because these cancers are not routinely reported by the SEER database.

Results  In the SEER-9 cohort (n = 1798), there were 197 second instances of cancer (SIR = 1.32; 95% confidence interval [CI], 1.15-1.52) at all sites. Significantly elevated risk (P<.01) was observed for Hodgkin disease (6 cases; SIR = 17.14; 95% CI, 6.25-37.26) and non-Hodgkin lymphoma (27 cases; SIR = 5.08; 95% CI, 3.34-7.38). Elevated risk (P<.05) was also observed for melanoma (10 cases; SIR = 2.60; 95% CI, 1.25-4.79), and urinary cancer (21 cases; SIR = 1.74; 95% CI, 1.08-2.66). In the Stanford University cohort (n = 429), there were 37 second instances of cancer (SIR = 1.04; 95% CI, 0.76-1.44). Elevated risk (P<.01) was observed for Hodgkin disease (3 cases; SIR = 27.27; 95% CI, 5.35-77.54). Elevated risk (P<.05) was also observed for biliary cancer (2 cases; SIR = 11.76; 95% CI, 1.51-42.02).

Conclusion  Updated SEER (population based) and Stanford (clinic based) data confirm the generalizability of earlier findings of increased risk of lymphoma in patients with mycosis fungoides or Sézary syndrome.

Author Affiliations: Departments of Dermatology (Drs Huang and Kim), Health Research and Policy (Dr Clarke), and Radiation Oncology (Dr Hoppe), Multidisciplinary Cutaneous Lymphoma Clinic (Drs Huang, Hoppe, and Kim), and Division of Biostatistics (Dr McMillan), Stanford University, Stanford, Calif; Dermatoepidemiology Unit, VA Medical Center Providence, Department of Dermatology, Rhode Island Hospital, and Departments of Dermatology and Community Health, Brown University, Providence, RI (Dr Weinstock); and Northern California Cancer Center, Fremont (Dr Clarke).

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