Second Primary Urinary Cancer in Hodgkin Lymphoma Survivors.

Abstract

PURPOSE/OBJECTIVE(S)\nHodgkin Lymphoma (HL) survivors have increased risk of secondary solid tumors and hematologic malignancies. Previous studies have demonstrated HL survivors to have increased incidence and worse survival outcomes after developing malignancies of the lung, breast, head & neck, and gastrointestinal tract. However, there are scarce data on overall survival (OS) for primary solid tumors of the urinary system, i.e., kidney, ureter, and bladder, in HL survivors relative to the general population.\n\n\nMATERIALS/METHODS\nA cohort study was conducted and examined 57,495 patients with primary urinary malignancy (kidney, ureter, bladder) and 192 who developed a secondary urinary cancer after HL (HL-U). The standardized incidence ratio (SIR) for urinary cancers, Kaplan-Meier OS and multivariable Cox regression modelling were performed. All patients were reported to the population-based Surveillance, Epidemiology, and End Results Program.\n\n\nRESULTS\nThe observed to expected ratio for second kidney, ureter, bladder malignancies were 1.60 (95% CI: [1.30-1.94], P < 0.05), 1.22 (95% CI: [1.00-1.48], P < 0.05), 3.86 (95% CI: [1.66-7.60], P < 0.05). HL survivors who developed bladder malignancy had a median OS of 69 months (95% CI: [50-136]) vs. 92 months (95% CI: [91-94]) in the general population (log rank P < 0.015). In the case of renal malignancies after HL patients had a median OS of 154 months (95% CI: [125-131]) vs. 128 months (95% CI: [110-n/a]) in the general population (log rank P\u202f=\u202f0.45). A multivariable Cox regression model accounting for age, sex, race, radiation/chemotherapy/surgery for urinary cancers, tumor grade, histology and stage showed HR 1.65 (95% CI: [1.21-2.27], P\u202f=\u202f0.0019), HR 1.20 (95% CI: [0.82-1.74], P\u202f=\u202f0.34), and HR 4.45 (95% CI: [1.4-14.3], P\u202f=\u202f0.01) for patients with secondary bladder, renal and ureter cancers, respectively.\n\n\nCONCLUSION\nCompared with patients who had de novo bladder and ureter malignancy, HL survivors experienced significantly decreased OS compared to the general population. Due to the increased incidence, increased mortality and poorer survival outcomes, HL survivors should be considered for surveillance of urinary cancers.