LONG-TERM MORTALITY AFTER A SINGLE TREATMENT COURSE WITH X-RAYS IN PATIENTS TREATED FOR ANKYLOSING-SPONDYLITIS
LONG-TERM MORTALITY AFTER A SINGLE TREATMENT COURSE WITH X-RAYS IN PATIENTS TREATED FOR ANKYLOSING-SPONDYLITIS
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DOI：
10.1038/bjc.1987.35
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发表时间：
1987-02-01
影响因子：
8.8
通讯作者：
SMITH, PG
中科院分区：
文献类型：
--
作者：
DARBY, SC;DOLL, R;SMITH, PG
在1935年至1954年期间，对14，106例接受单疗程X线治疗的强直性脊柱炎患者进行了截至1983年1月1日的死亡率研究。对于白血病或结肠癌以外的肿瘤，死亡率比英格兰和威尔士普通人群高出28%，这种增加很可能是治疗的直接后果。在照射后10.0 ~ 12.4年之间，比例增加达到最大值71%，然后下降。辐射后25年以上，这些肿瘤的死亡率仅增加7%，在此期间，只有食道癌的相对风险显著增加。无论是相对风险的大小，还是治疗后的时间模式，都不会受到首次治疗时患者年龄的很大影响。对于白血病，死亡率增加了三倍，这也可能是由于放射治疗。相对危险度在治疗后2.5 ~ 4.9年最高，随后下降，但上升趋势并未完全消失，治疗后25.0年以上，相对危险度仍接近普通人群的2倍。有一些证据表明，急性骨髓性白血病、急性淋巴性白血病和慢性骨髓性白血病的风险都增加了，但没有证据表明慢性淋巴性白血病的风险增加。急性髓性白血病的相对风险似乎最大。对于结肠癌，它与脊柱炎通过一个共同的协会与溃疡性结肠炎，死亡率增加了30%。对于非肿瘤性疾病，死亡率增加了51%，这可能与疾病本身有关，而不是与治疗有关。这种增加在广泛的疾病中是明显的，并不局限于临床上与强直性脊柱炎相关的疾病。
Mortality up to 1 January 1983 has been studied in 14,106 patients with ankylosing spondylitis given a single course of X-ray treatment during 1935-54. For neoplasms other than leukaemia or colon cancer, mortality was 28% greater than that of members of the general population of England and Wales, and this increase is likely to have been a direct consequence of the treatment. The proportional increase reached a maximum of 71% between 10.0 and 12.4 years after irradiation and then declined. There was only a 7% increase in mortality from these tumours more than 25.0 years after irradiation and only for cancer of the oesophagus was the relative risk significantly raised in this period. Neither the magnitude of the relative risk, nor its temporal pattern following treatment, were greatly influenced by the age of the patient at first treatment. For leukaemia there was a threefold increase in mortality that is also likely to have been due to the radiotherapy. The relative risk was at its highest between 2.5 and 4.9 years after the treatment and then declined, but the increse did not disappear completely, and the risk was still nearly twice that of the general population more than 25.0 years after treatment. There was some evidence that the risks of acute myeloid, acute lymphatic, and chronic myeloid leukaemia were all increased, but no evidence of any increase in chronic lymphatic leukaemia. The relative risk appeared to be greatest for acute myeloid leukaemia. For colon cancer, which is associated with spondylitis through a common association with ulcerative colitis, mortality was increased by 30%. For non-neoplastic conditions there was a 51% increase in mortality that was likely to be associated with the disease itself rather than its treatment. The increase was apparent for a wide range of diseases and was not confined to diseases that have been associated clinically with ankylosing spondylitis.