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Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer

An indirect consequence of the improved long-term survival seen in patients with breast cancer (BC) is the increased risk of hematologic malignant neoplasms (HM). This study aimed to analyze the role of postoperative treatment for BC in the development of subsequent HM. Using the French National Hea...

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Autores principales: Jabagi, Marie Joelle, Goncalves, Anthony, Vey, Norbert, Le Tri, Thien, Zureik, Mahmoud, Dray-Spira, Rosemary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827362/
https://www.ncbi.nlm.nih.gov/pubmed/31569513
http://dx.doi.org/10.3390/cancers11101463
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author Jabagi, Marie Joelle
Goncalves, Anthony
Vey, Norbert
Le Tri, Thien
Zureik, Mahmoud
Dray-Spira, Rosemary
author_facet Jabagi, Marie Joelle
Goncalves, Anthony
Vey, Norbert
Le Tri, Thien
Zureik, Mahmoud
Dray-Spira, Rosemary
author_sort Jabagi, Marie Joelle
collection PubMed
description An indirect consequence of the improved long-term survival seen in patients with breast cancer (BC) is the increased risk of hematologic malignant neoplasms (HM). This study aimed to analyze the role of postoperative treatment for BC in the development of subsequent HM. Using the French National Health Data System, we examined the HM risks in patients diagnosed with an incident primary breast cancer between 2007 and 2015, who underwent surgery as first-line treatment for BC. Main outcomes were acute myeloid leukemia (AML), Myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), multiple myeloma (MM), Hodgkin’s lymphoma or non-Hodgkin’s lymphoma (HL/NHL), and acute lymphoblastic leukemia or lymphocytic lymphoma (ALL/LL). Analyses were censored at HM occurrence, death, loss to follow up, or December 2017. The risk of each type of HM was compared according to the initial postoperative treatment of breast cancer. Of a total of 324,056 BC survivors, 15.5% underwent surgery only, 46.7% received radiotherapy after surgery, 4.3% received chemotherapy after surgery, and 33.5% received all three modalities. Overall, 2236 cases of hematologic malignancies occurred. Compared to the surgery alone group, AML was significantly increased after surgery plus radiation (aHR, 1.5; 95% CI, 1.0–2.1), surgery plus chemotherapy (aHR, 2.1; 95% CI, 1.2–3.6) and all modalities (aHR, 3.3; 95% CI, 2.3–4.7). MDS was significantly increased after surgery plus chemotherapy (aHR, 1.7; 95% CI, 1.1–2.5) or after all modalities (aHR, 1.4; 95% CI, 1.1–1.8). HL/NHL were significantly increased only in the radiotherapy and surgery group (aHR, 1.3; 95% CI, 1.0–1.6). A nonsignificant increase of ALL/LL (aHR, 1.8; 95% CI, 0.6–3.5) was noted after chemotherapy and with all three modalities (aHR, 1.4; 95% CI, 0.7–2.8). Our population based study revealed increased risks of various HM associated with postoperative BC treatment. The added benefit of chemotherapy and radiation therapy should take into consideration these long-term complications.
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spelling pubmed-68273622019-11-18 Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer Jabagi, Marie Joelle Goncalves, Anthony Vey, Norbert Le Tri, Thien Zureik, Mahmoud Dray-Spira, Rosemary Cancers (Basel) Article An indirect consequence of the improved long-term survival seen in patients with breast cancer (BC) is the increased risk of hematologic malignant neoplasms (HM). This study aimed to analyze the role of postoperative treatment for BC in the development of subsequent HM. Using the French National Health Data System, we examined the HM risks in patients diagnosed with an incident primary breast cancer between 2007 and 2015, who underwent surgery as first-line treatment for BC. Main outcomes were acute myeloid leukemia (AML), Myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), multiple myeloma (MM), Hodgkin’s lymphoma or non-Hodgkin’s lymphoma (HL/NHL), and acute lymphoblastic leukemia or lymphocytic lymphoma (ALL/LL). Analyses were censored at HM occurrence, death, loss to follow up, or December 2017. The risk of each type of HM was compared according to the initial postoperative treatment of breast cancer. Of a total of 324,056 BC survivors, 15.5% underwent surgery only, 46.7% received radiotherapy after surgery, 4.3% received chemotherapy after surgery, and 33.5% received all three modalities. Overall, 2236 cases of hematologic malignancies occurred. Compared to the surgery alone group, AML was significantly increased after surgery plus radiation (aHR, 1.5; 95% CI, 1.0–2.1), surgery plus chemotherapy (aHR, 2.1; 95% CI, 1.2–3.6) and all modalities (aHR, 3.3; 95% CI, 2.3–4.7). MDS was significantly increased after surgery plus chemotherapy (aHR, 1.7; 95% CI, 1.1–2.5) or after all modalities (aHR, 1.4; 95% CI, 1.1–1.8). HL/NHL were significantly increased only in the radiotherapy and surgery group (aHR, 1.3; 95% CI, 1.0–1.6). A nonsignificant increase of ALL/LL (aHR, 1.8; 95% CI, 0.6–3.5) was noted after chemotherapy and with all three modalities (aHR, 1.4; 95% CI, 0.7–2.8). Our population based study revealed increased risks of various HM associated with postoperative BC treatment. The added benefit of chemotherapy and radiation therapy should take into consideration these long-term complications. MDPI 2019-09-29 /pmc/articles/PMC6827362/ /pubmed/31569513 http://dx.doi.org/10.3390/cancers11101463 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jabagi, Marie Joelle
Goncalves, Anthony
Vey, Norbert
Le Tri, Thien
Zureik, Mahmoud
Dray-Spira, Rosemary
Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title_full Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title_fullStr Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title_full_unstemmed Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title_short Risk of Hematologic Malignant Neoplasms after Postoperative Treatment of Breast Cancer
title_sort risk of hematologic malignant neoplasms after postoperative treatment of breast cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827362/
https://www.ncbi.nlm.nih.gov/pubmed/31569513
http://dx.doi.org/10.3390/cancers11101463
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