Risk of selected subsequent carcinomas in survivors of childhood cancer: A report from the childhood cancer survivor study
Risk of selected subsequent carcinomas in survivors of childhood cancer: A report from the childhood cancer survivor study
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DOI：
10.1200/jco.2005.02.7235
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发表时间：
2006-01-20
影响因子：
45.3
通讯作者：
Kadan-Lottick, NS
中科院分区：
文献类型：
--
作者：
Bassal, M;Mertens, AC;Kadan-Lottick, NS
目的确定除乳腺癌、甲状腺癌和皮肤癌以外的其他癌症的风险，并确定影响儿童癌症幸存者风险的因素。患者和方法13136名参与者(存活！儿童癌症幸存者研究的恶性肿瘤后5年，诊断于1970年至1986年，年龄< 21岁)，使用监测、流行病学和最终结果数据计算标准化发病率（SIRs）。结果在71例患者中，71例肿瘤的诊断年龄中位数为27岁，平均时间为15年，分别发生在泌尿生殖系统（35%）、头颈部（32%）、胃肠道（23%）和其他部位（10%）。59例（83%）患者接受过放疗，42例（59%）患者在之前的放疗中再次发生恶性肿瘤。除中枢神经系统肿瘤外，所有儿童期诊断的风险均显著升高，其中神经母细胞瘤（SIR = 24.2）和软组织肉瘤（SIR = 6.2）的风险最高。神经母细胞瘤的幸存者患肾细胞癌的风险增加329倍；霍奇金淋巴瘤的幸存者患胃肠道癌的风险增加了4.5倍。软组织肉瘤（SIR = 22.6）、神经母细胞瘤（SIR = 20.9）和白血病（SIR = 20.9）的幸存者患头颈部癌的风险显著升高。结论：儿童癌症的年轻幸存者患成年后典型癌症的风险增加，强调了长期随访和基于风险的筛查的重要性。正在对该队列进行随访，以确定终生风险并描述导致风险的个体特征。
Purpose To determine the risk of subsequent carcinomas other than breast, thyroid, and skin, and to identify factors that influence the risk among survivors of childhood cancer.Patients and Methods Subsequent malignant neoplasm history was determined in 13,136 participants (surviving ! 5 years postmalignancy, diagnosed from 1970 to 1986 at age < 21 years) of the Childhood Cancer Survivor Study to calculate standardized incidence ratios (SIRs), using Surveillance, Epidemiology, and End Results data.Results In 71 individuals, 71 carcinomas were diagnosed at a median age of 27 years and a median elapsed time of 15 years in the genitourinary system (35%), head and neck area (32%), gastrointestinal tract (23%), and other sites (10%). Fifty-nine patients (83%) had received radiotherapy, and 42 (59%) developed a second malignant neoplasm in a previous radiotherapy field. Risk was significantly elevated following all childhood diagnoses except CNS neoplasms, and was highest following neuroblastoma (SIR = 24.2) and soft tissue sarcoma (SIR = 6.2). Survivors of neuroblastoma had a 329-fold increased risk of renal cell carcinomas; survivors of Hodgkin's lymphoma had a 4.5-fold increased risk of gastrointestinal carcinomas. Significantly elevated risk of head and neck carcinoma occurred in survivors of soft tissue sarcoma (SIR = 22.6), neuroblastoma (SIR = 20.9), and leukemia (SIR = 20.9).Conclusion Young survivors of childhood cancers are at increased risk of developing subsequent carcinomas typical of later adulthood, underscoring the importance of long-term follow-up and risk-based screening. Follow-up of the cohort is ongoing to determine lifetime risk and delineate individual characteristics that contribute to risk.