Racial/Ethnic Differences in Adverse Outcomes Among Childhood Cancer Survivors: The Childhood Cancer Survivor Study
Racial/Ethnic Differences in Adverse Outcomes Among Childhood Cancer Survivors: The Childhood Cancer Survivor Study
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DOI：
10.1200/jco.2015.66.3567
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发表时间：
2016-05-10
影响因子：
45.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
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作者：
Liu, Qi;Leisenring, Wendy M.;Bhatia, Smita
目的儿童癌症幸存者背负着与治疗相关的高发病率负担；然而，种族/民族特定的不良结局风险并未得到很好的了解。方法利用儿童癌症幸存者研究的数据，至少5年的幸存者队列，比较西班牙裔(n=750，5.4%)和非西班牙裔黑人(NHB：N=694，5.0%)幸存者与非西班牙裔白人患者(NHW：N=12,397，89.6%)的晚期死亡率、后续肿瘤和慢性健康状况。结果NHBs和拉美裔报告较低的社会经济地位(SES)和较高的肥胖率，NHBs报告较高的高血压患病率。NHBs的全因死亡率较高(相对危险度[RR]为1.4；95%CI为1.1~1.9；P=.008)，调整SES因素后，全因死亡率被取消(RR为1.0；95%CI为0.8~1.4；P=0.9)。非黑色素瘤皮肤癌在受照射的NHBs中未被观察到，与NHW相比，西班牙裔幸存者的风险较低(RR，0.3；95%CI，0.1~0.7)。NHBs和西班牙裔都显示出患糖尿病的风险增加；在调整了SES和肥胖因素后，这些风险仍然存在(NHBs：RR，2.8；95%CI，1.1至6.7；西班牙裔：RR，3.1；95%CI，1.5至6.4)。NHBs更有可能报告心脏疾病(RR，1.8；95%CI，1.1至2.7)，但在调整心血管危险因素后，风险降低。治疗暴露对死亡率(所有原因或特定原因)、慢性健康状况或后续肿瘤的种族/民族差异没有影响。结论总的来说，NHB和西班牙裔儿童癌症幸存者的发病率和死亡率负担与他们的NHW同龄人相似。风险方面的少数差异是由于种族/民族在社会经济地位和/或心血管风险因素上的差异。(C)2016年度美国临床肿瘤学会
PurposeChildhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ethnicity-specific risks of adverse outcomes are not well understood.MethodsData from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to nonHispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions.ResultsNHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms.ConclusionBy and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to theirNHWcounterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors. (C) 2016 by American Society of Clinical Oncology