2ND MALIGNANCIES IN VERY-LONG-TERM SURVIVORS OF CHILDHOOD-CANCER
2ND MALIGNANCIES IN VERY-LONG-TERM SURVIVORS OF CHILDHOOD-CANCER
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DOI：
10.1016/0002-9343(92)90680-a
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发表时间：
1992-07-01
影响因子：
5.9
通讯作者：
ZARANEK, B
中科院分区：
文献类型：
--
作者：
BLATT, J;OLSHAN, A;ZARANEK, B
目的：虽然大多数第二恶性肿瘤与治疗相关，但其发生也可能是由于潜在的全身性疾病或致瘤性多个器官共有的染色体异常所致。我们试图识别不寻常的肿瘤对，这可能为共同的遗传病因学提供线索。患者和方法：回顾了 1,743 名患者（诊断时 0 至 18 岁）的医疗记录和肿瘤登记对应情况。对于那些据说患有第二种恶性肿瘤的患者，我们对活检和尸检记录以及切片进行了审查，以确认初次和二次诊断。结果：258 名患者进行了至少 10 年的随访，157 名患者进行了至少 20 年的随访。 14 名患者发现第二恶性肿瘤。据估计，10 年内第二种癌症的累积发病率约为 1%。诊断后 20 年，精算估计为 3%。尽管大多数第二种癌症可能与治疗相关，但有几个肿瘤对无法在此基础上得到清楚的解释，包括甲状腺癌、卵巢肉瘤和与肾平滑肌肉瘤相关的急性淋巴细胞白血病。根据本系列中的一个病例以及对文献的回顾，提出了肾母细胞瘤、腹部放射、结肠腺癌和肝细胞癌之间的关联。结论。我们的结论是，对儿童癌症长期幸存者的持续监测（通常由内科医生、家庭医生和成年肿瘤学家完成）可能是确定第二种恶性肿瘤终生发病率的一种方法。此外，尽管产量可能很小，但对意想不到的肿瘤对的描述可能会将家庭作为多效性遗传异常研究的目标。
PURPOSE: Although most second malignancies are treatment related, their occurrence also may be due to an underlying systemic disease or chromosomal a normalities shared by multiple organs in which they are tumorigenic. We attempted to identify unusual tumor pairs that might provide a clue to shared genetic etiologies. PATIENTS AND METHODS: Medical records and tumor registry correspondence of 1,743 patients (0 to 18 years at diagnosis) were reviewed. For those said to have a second malignancy, biopsy and autopsy records and slides were reviewed to confirm initial and secondary diagnoses.RESULTS: Two hundred fifty-eight patients had follow-up of at least 10 years and 157 of at least 20 years. Second malignancies were identified in 14 patients. The estimated cumulative incidence of a second cancer was approximately 1 % within 10 years. At 20 years after diagnosis, the actuarial estimate was 3%. Although most second cancers were likely treatment related, several tumor pairs could not clearly be explained on that basis, including thyroid carcinoma followed by an ovarian sarcoma, and acute lymphoblastic leukemia associated with renal leiomyosarcoma. Based on one case in this series and a review of the literature, associations between Wilms' tumor, abdominal radiation, and adenocarcinoma of the colon and hepatocellular carcinoma are suggested.CONCLUSIONs. We conclude that continued surveillance of very-long-term survivors of childhood cancer, which is usually accomplished by internists, family practitioners, and adult oncologists, may be one approach to defining the lifetime incidence of second malignancies. In addition, although the yield is likely to be small, descriptions of unexpected tumor pairs may target families for studies of pleiotropic genetic abnormalities.