Survivors of Childhood Cancer Have Increased Risk of Gastrointestinal Complications Later in Life
Survivors of Childhood Cancer Have Increased Risk of Gastrointestinal Complications Later in Life
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DOI：
10.1053/j.gastro.2011.01.049
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发表时间：
2011-05-01
期刊：
影响因子：
29.4
通讯作者：
Diller, Lisa
中科院分区：
文献类型：
--
作者：
Goldsby, Robert;Chen, Yan;Diller, Lisa
背景与目的：接受癌症治疗的儿童会经历许多急性胃肠道（GI）毒性。然而，长期GI后果尚未得到广泛研究。我们评估了长期GI结果的发生率，并确定了治疗相关的风险因素。方法：采用正交设计法在儿童癌症幸存者研究的参与者的病例中评估了上消化道、肝脏和下消化道的不良结局，该研究包括1970年至1986年诊断的14，358名儿童癌症幸存者;数据与随机选择的兄弟姐妹进行了比较。癌症诊断时的中位年龄为6.8岁（范围，0-21.0岁），存活者和兄弟姐妹结局评估时的中位年龄分别为23.2岁（5.6-48.9岁）和26.6岁（1.8-56.2岁）。确定自我报告的晚期GI并发症（发生在癌症诊断后5年或更长时间）的发生率，并将其与患者特征和癌症治疗相关联，调整年龄，性别和种族。研究结果：与同胞相比，幸存者的上消化道（率比[RR]，1.8; 95%置信区间[CI]，1.6-2.0）、肝脏（RR，2.1; 95% CI，1.8-2.5）和下消化道（RR，1.9; 95% CI，1.7-2.2）迟发性并发症风险增加。需要结肠造口术/回肠造口术、肝活检或发生肝硬化的RR分别为5.6（95% CI，2.4-13.1）、24.1（95% CI，7.5-77.8）和8.9（95% CI，2.0-40.0）。诊断时年龄较大，强化治疗，腹部放疗和腹部手术增加了某些胃肠道并发症的风险。结论：儿童时期接受癌症治疗的个体在以后的生活中发生胃肠道并发症的风险增加。
BACKGROUND & AIMS: Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors. METHODS: Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0-21.0 years), and the median age at outcome assessment was 23.2 years (5.6-48.9 years) for survivors and 26.6 years (1.8-56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race. RESULTS: Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6-2.0), liver (RR, 2.1; 95% CI, 1.8-2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7-2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4-13.1), 24.1 (95% CI, 7.5-77.8), and 8.9 (95% CI, 2.0-40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications. CONCLUSIONS: Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.