Aging and Risk of Severe, Disabling, Life-Threatening, and Fatal Events in the Childhood Cancer Survivor Study
Aging and Risk of Severe, Disabling, Life-Threatening, and Fatal Events in the Childhood Cancer Survivor Study
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DOI：
10.1200/jco.2013.51.1055
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发表时间：
2014-04-20
影响因子：
45.3
通讯作者：
Oeffinger, Kevin C.
中科院分区：
文献类型：
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作者：
Armstrong, Gregory T.;Kawashima, Toana;Oeffinger, Kevin C.
目的第一代儿童癌症幸存者现已步入40岁和50岁，但整个老龄化过程中的健康风险尚未得到很好的确定。方法分析来自儿童癌症幸存者研究的14,359名5年幸存者，他们在21岁以下首次确诊，并在确诊后与他们的4,301名兄弟姐妹一起接受了中位数24.5年的随访(范围从5.0到39.3年)。在幸存者中，5604人在最后一次随访时年龄至少35岁(年龄从35岁到62岁)。根据美国国家癌症研究所的不良事件通用术语标准，对诊断后5年以上的严重、致残、危及生命和致命的健康状况进行分类。结果到50岁时，幸存者的严重、致残、危及生命或致命的健康状况的累积发生率高于同胞(53.6%；95%可信区间，51.5~55.6；v19.8%；95%可信区间，17.0~22.7)。当将幸存者与兄弟姐妹进行比较时，5-19岁年龄组(HR，6.8；95%CI，5.5-8.3)、20-34岁年龄组(HR，3.8；95%CI，3.2-4.5)和35岁年龄组(HR，5.0；95%CI，4.1-6.1)的危险比(HR)显著增加，其中35岁组HR显著高于20-34岁组(P=.03)。在35岁的幸存者中，25.9%的人在10年内经历了随后的3至5级病情，而兄弟姐妹中的这一比例为6.0%(P<；.001)。结论幸存者的发病率和死亡率在40年后进一步增加，这影响了这一人群未来的临床需求，而不是持续的监测和干预。
Purpose The first generation of childhood cancer survivors is now aging into their fourth and fifth decades of life, yet health risks across the aging spectrum are not well established.Methods Analyses included 14,359 5-year survivors from the Childhood Cancer Survivor Study, who were first diagnosed when they were younger than 21 years old and who received follow-up for a median of 24.5 years after diagnosis (range, 5.0 to 39.3 years) along with 4,301 of their siblings. Among the survivors, 5,604 were at least 35 years old (range, 35 to 62 years) at last follow-up. Severe, disabling, life-threatening, and fatal health conditions more than 5 years from diagnosis were classified using the Common Terminology Criteria for Adverse Events, grades 3 to 5 (National Cancer Institute).Results The cumulative incidence of a severe, disabling, life-threatening, or fatal health condition was greater among survivors than siblings (53.6%; 95% CI, 51.5 to 55.6; v 19.8%; 95% CI, 17.0 to 22.7) by age 50 years. When comparing survivors with siblings, hazard ratios (HR) were significantly increased within the age group of 5 to 19 years (HR, 6.8; 95% CI, 5.5 to 8.3), age group of 20 to 34 years (HR, 3.8; 95% CI, 3.2 to 4.5), and the 35 years group (HR, 5.0; 95% CI, 4.1 to 6.1), with the HR significantly higher among those 35 years versus those 20 to 34 years old (P = .03). Among survivors who reached age 35 years without a previous grade 3 or 4 condition, 25.9% experienced a subsequent grade 3 to 5 condition within 10 years, compared with 6.0% of siblings (P < .001).Conclusion Elevated risk for morbidity and mortality among survivors increases further beyond the fourth decade of life, which affects the future clinical demands of this population relative to ongoing surveillance and interventions.