Racial/Ethnic Disparities on the Risk of Second Malignant Neoplasm Among Hodgkin Lymphoma Survivors

Han Xiao; Jianghua He; Simin Liang; Duo Cai; Qiao Zhou; Lanxiang Liu; Xinyu Yan; Jianxiang Chi; Qing Xiao; Li Wang

doi:10.3389/fonc.2021.790891

Racial/Ethnic Disparities on the Risk of Second Malignant Neoplasm Among Hodgkin Lymphoma Survivors

Front Oncol. 2022 Jan 24:11:790891. doi: 10.3389/fonc.2021.790891. eCollection 2021.

Authors

Han Xiao¹, Jianghua He², Simin Liang¹, Duo Cai¹, Qiao Zhou¹, Lanxiang Liu¹, Xinyu Yan¹, Jianxiang Chi³, Qing Xiao¹, Li Wang¹

Affiliations

¹ Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
² Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States.
³ The Center for the Study of Hematological Malignancies, Karaiskakio Foundation, Nicosia, Cyprus.

Abstract

Background: Hodgkin lymphoma survivors are at risk for second malignant neoplasm (SMN). How race/ethnicity affects the risk remains unclear.

Methods: This retrospective cohort study included 22,415 patients diagnosed with primary Hodgkin lymphoma from January 1992 to December 2015 in 13 Surveillance, Epidemiology, and End Results-based registries and divided patients into four groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asian/others. Taking non-Hispanic whites as a reference, both the proportional subdistribution hazard (PSH) and the cause-specific hazard (CSH) methods were used to calculate the SMN hazard ratio for other racial/ethnic groups with and without considering the competing mortality risk.

Results: 1,778 patients developed SMN with a median follow-up of 11.63 years. In the adjusted PSH model, Hispanic, Asian/others, and non-Hispanic black patients had 26% (PSH, 0.74; 95% CI, 0.63-0.87), 20% (PSH, 0.80; 95% CI, 0.64-1.01), and 12% (PSH, 0.88; 95% CI, 0.75-1.03) decreased overall SMN hazard, respectively. Moreover, the PSH method revealed the racial/ethnic difference in the SMN risk in the skin, the respiratory system, and the endocrine system. These hazards were slightly higher and different with the use of the CSH approach. In addition to the aforementioned overall SMN and subtypes, adjusted CSH analysis also revealed the racial/ethnic disparities in the risk of subsequent female breast cancer, digestive cancer, and non-Hodgkin lymphoma.

Conclusions: The subtype and SMN risk among Hodgkin lymphoma survivors varied by race/ethnicity. The use of CSH and PSH provides a dynamic view of racial/ethnic effects on SMN risk in Hodgkin lymphoma survivors.

Keywords: Hodgkin lymphoma; SEER database; cancer surveillance; racial/ethnic disparities; second malignant neoplasm.