Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study
Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study
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DOI：
10.1200/jco.2008.21.1425
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发表时间：
2009-05-10
影响因子：
45.3
通讯作者：
Mertens, Ann C.
中科院分区：
文献类型：
--
作者：
Armstrong, Gregory T.;Liu, Qi;Mertens, Ann C.
儿童癌症幸存者研究（CCSS）组建了迄今为止最大规模的队列，用于评估晚期死亡率。通过使用国家死亡索引和死亡证明确定了所有有资格参与CCSS的患者的生存状况和死亡原因，以描述20483名幸存者的死亡情况，这些幸存者的观察人年数为337334。截至2002年12月31日，共有2821人死亡。从确诊起30年时的总体累积死亡率为18.1%（95%置信区间，17.3 - 18.9）。随着时间推移，虽然全因死亡率一直保持稳定，但晚期死亡的模式正在发生变化。原发性疾病复发或进展导致的死亡率正在下降，而继发肿瘤（标准化死亡比[SMR]，15.2；95%置信区间，13.9 - 16.6）、心脏死亡（SMR，7.0；95%置信区间，5.9 - 8.2）和肺部死亡（SMR，8.8；95%置信区间，6.8 - 11.2）导致的死亡率上升，这主要是由于治疗相关原因。此外，CCSS已经确定了与晚期死亡相关的特定治疗风险因素。放疗（相对风险[RR]，2.9；95%置信区间，2.1 - 4.2）、烷化剂（RR，2.2；95%置信区间，1.6 - 3.0）和鬼臼毒素类药物（RR，2.3；95%置信区间，1.2 - 4.5）增加了继发恶性肿瘤导致死亡的风险。心脏辐射暴露（RR，3.3；95%置信区间，2.0 - 5.5）和高剂量蒽环类药物暴露（RR，3.1；95%置信区间，1.6 - 5.8）与晚期心脏死亡相关。通过对该队列持续进行纵向随访，并将队列扩大到包括1987年至1999年期间确诊的患者，CCSS将仍然是评估儿童癌症幸存者晚期死亡率的主要资源。
The Childhood Cancer Survivor Study (CCSS) has assembled the largest cohort to date for assessment of late mortality. Vital status and cause of death of all patients eligible for participation in CCSS was determined using the National Death Index and death certificates to characterize the mortality experience of 20,483 survivors, representing 337,334 person-years of observation. A total of 2,821 deaths have occurred as of December 31, 2002. The overall cumulative mortality is 18.1% (95% CI, 17.3 to 18.9) at 30 years from diagnosis. With time, while all-cause mortality rates have been stable, the pattern of late death is changing. Mortality attributable to recurrence or progression of primary disease is decreasing, with increases in rates of mortality attributable to subsequent neoplasms (standardized mortality ratios [SMR], 15.2; 95% CI, 13.9 to 16.6), cardiac death (SMR, 7.0; 95% CI, 5.9 to 8.2), and pulmonary death (SMR, 8.8; 95% CI, 6.8 to 11.2) largely due to treatment-related causes. In addition, the CCSS has identified specific treatment-related risk factors for late mortality. Radiotherapy (relative risk [RR], 2.9; 95% CI, 2.1 to 4.2), alkylating agents (RR, 2.2; 95% CI, 1.6 to 3.0), and epipodophyllotoxins (RR, 2.3; 95% CI, 1.2 to 4.5) increase the risk of death due to subsequent malignancy. Cardiac radiation exposure (RR, 3.3; 95% CI, 2.0 to 5.5) and high dose of anthracycline exposure (RR, 3.1; 95% CI, 1.6 to 5.8) are associated with late cardiac death. By continued longitudinal follow-up of the cohort and expansion of the cohort to include patients diagnosed between 1987 and 1999, the CCSS will remain a primary resource for assessment of late mortality of survivors of childhood cancers.