{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:20:01Z","timestamp":1790878801680,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Previous studies have shown an increased risk of secondary primary malignancies (SPMs) after diffuse large B\u2010cell lymphoma (DLBCL) treatment. Whether stage of DLBCL at diagnosis affects the subtypes of SPMs that occur has not been previously described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Surveillance, Epidemiology, and End Results database was queried for patients aged &gt;18\u00a0years diagnosed with primary DLBCL from 1973 to 2010 and categorized by early stage (ES) (stage I\u2010II) or advanced stage (AS) (stage III\u2010IV) disease. Differences in overall and location\u2010specific SPM incidence by stage and time since diagnosis were assessed in 5\u2010year intervals using a Fine\u2010Gray hazards model. Overall survival was compared using the log\u2010rank test. A Cox proportional hazards model was used to assess differences in survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 26,038 patients with DLBCL were identified, including 14,724 with ES and 11,314 with AS disease. The median follow\u2010up was 13.3\u00a0years. Overall, 13.0% of patients developed SPM, with a higher but nonsignificantly increased risk of SPM development in those who had ES disease compared with those who had AS disease (14% vs 11.6%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.14). During the first 5\u00a0years after diagnosis, patients who had ES disease had a higher risk of SPM than those who had AS disease, specifically colorectal, pancreas, breast, and prostate SPMs. During the period from 10 to 15\u00a0years after diagnosis, patients who had AS disease had a higher risk of SPM than those who had ES disease, specifically hematologic SPMs. Development of SPM was found to significantly increase the risk of death regardless of stage at diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this large, population\u2010based study, distinctly different subtypes and temporal patterns of SPM development were identified based on stage of DLBCL at diagnosis. The current study merits consideration of tailored site\u2010specific and time\u2010specific surveillance for patients with DLBCL according to stage and time interval since diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32513","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T08:58:23Z","timestamp":1568192303000},"page":"189-201","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Risk and subtypes of secondary primary malignancies in diffuse large B\u2010cell lymphoma survivors change over time based on stage at diagnosis"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7261-1335","authenticated-orcid":false,"given":"Ajay","family":"Major","sequence":"first","affiliation":[{"name":"Department of Medicine Internal Medicine Residency Training Program University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cancer Center Biostatistics Core University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6618-1316","authenticated-orcid":false,"given":"Debashis","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics Colorado School of Public Health Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Rabinovitch","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manali","family":"Kamdar","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hematology University of Colorado School of Medicine Aurora Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30164"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.29.1112"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21349"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdq697"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14638"},{"key":"e_1_2_9_7_1","first-page":"1809","article-title":"Risk of second primary cancer in patients with B\u2010cell non\u2010Hodgkin lymphoma receiving rituximab\u2010containing chemotherapy: a nationwide population\u2010based study","volume":"35","author":"Cho SF","year":"2015","journal-title":"Anticancer Res"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2008.07.002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1182\/blood.V108.11.809.809","article-title":"Gene expression differences between low and high stage diffuse large B cell lymphoma (DLBCL)","volume":"108","author":"Roberts RA","year":"2006","journal-title":"Blood"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.24.5860"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.65.4582"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2017-000172"},{"key":"e_1_2_9_13_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2015"},{"key":"e_1_2_9_14_1","volume-title":"SAS 9.3 Language Reference","author":"SAS Institute, Inc","year":"2012"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_9_16_1","unstructured":"GerdsTA ScheikeTH BlancheP OzenneB.riskRegression: Risk Regression Models and Prediction Scores for Survival Analysis with Competing Risks. 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