Prevalence and Risk Factors of Early Endocrine Disorders in Childhood Brain Tumor Survivors: A Nationwide, Multicenter Study
Prevalence and Risk Factors of Early Endocrine Disorders in Childhood Brain Tumor Survivors: A Nationwide, Multicenter Study
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DOI：
10.1200/jco.2016.67.5025
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发表时间：
2016-12-20
影响因子：
45.3
通讯作者：
van Santen, Hanneke M.
中科院分区：
文献类型：
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作者：
Clement, Sarah C.;Schouten-van Meeteren, Antoinette Y. N.;van Santen, Hanneke M.
目的探讨儿童脑肿瘤幸存者（CBTS）早期内分泌紊乱的患病率及其危险因素。患者和方法这项全国性的研究队列包括718名在2002年至2012年间被诊断为CBTS的患者，他们在诊断后存活了bb0 = 2年。排除颅咽管瘤或垂体瘤患者。所有内分泌调查的结果，在诊断和随访期间进行，从患者的图表收集。多变量logistic回归用于研究人口统计学、肿瘤和治疗相关变量与早期内分泌疾病患病率之间的关系。结果中位随访6.6年后，178名CBTS（24.8%）被诊断为内分泌紊乱。共有159名CBTS（22.1%）在诊断后的前5年内出现至少一种内分泌紊乱。最常见的内分泌失调是生长激素缺乏症（12.5%）、性早熟（12.2%）、促甲状腺激素缺乏症（9.2%）和甲状腺功能减退（5.8%）。下丘脑-垂体功能障碍（n = 138）的风险与放疗相关（比值比[OR]， 15.74; 95% CI， 8.72至28.42）、诊断时年龄较小（OR, 1.09; 95% CI， 1.04至1.14）、随访时间较长（OR, 1.10; 95% CI， 1.02至1.18）、诊断时脑积水（OR, 1.77; 95% CI， 1.09至2.88）、鞍上（OR, 34.18; 95% CI， 14.74至79.29）和幕下（OR, 2.65; 95% CI， 1.48至4.74）肿瘤部位。结论CBTS患者早期内分泌失调发生率较高。观察到22.1%的CBTS在诊断后的前5年内出现至少一种内分泌紊乱，这强调了早期和定期评估有内分泌损伤风险的CBTS内分泌功能的重要性。(C) 2016年由美国临床肿瘤学会出版
PurposeTo evaluate the prevalence of, and risk factors for, early endocrine disorders in childhood brain tumor survivors (CBTS).Patients and MethodsThis nationwide study cohort consisted of 718 CBTS who were diagnosed between 2002 and 2012, and who survived >= 2 years after diagnosis. Patients with craniopharyngeoma or a pituitary gland tumor were excluded. Results of all endocrine investigations, which were performed at diagnosis and during follow-up, were collected from patient charts. Multivariable logistic regression was used to study associations between demographic and tumor-and treatment-related variables and the prevalence of early endocrine disorders.ResultsAfter a median follow-up of 6.6 years, 178 CBTS (24.8%) were diagnosed with an endocrine disorder. A total of 159 CBTS (22.1%) presented with at least one endocrine disorder within the first 5 years after diagnosis. The most common endocrine disorders were growth hormone deficiency (12.5%), precocious puberty (12.2%), thyroid-stimulating hormone deficiency (9.2%), and thyroidal hypothyroidism (5.8%). The risk of hypothalamic-pituitary dysfunction (n = 138) was associated with radiotherapy (odds ratio [OR], 15.74; 95% CI, 8.72 to 28.42), younger age at diagnosis (OR, 1.09; 95% CI, 1.04 to 1.14), advanced follow-up time (OR, 1.10; 95% CI, 1.02 to 1.18), hydrocephalus at diagnosis (OR, 1.77; 95% CI, 1.09 to 2.88), and suprasellar (OR, 34.18; 95% CI, 14.74 to 79.29) and infratentorial (OR, 2.65; 95% CI, 1.48 to 4.74) tumor site.ConclusionThe prevalence of early endocrine disorders among CBTS is high. The observation that 22.1% of CBTS developed at least one endocrine disorder within the first 5 years after diagnosis stresses the importance of early and regular assessment of endocrine function in CBTS who are at risk for endocrine damage. (C) 2016 by American Society of Clinical Oncology