Long-term cause-specific mortality of patients treated for Hodgkin's disease
Long-term cause-specific mortality of patients treated for Hodgkin's disease
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DOI：
10.1200/jco.2003.07.131
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发表时间：
2003-09-15
影响因子：
45.3
通讯作者：
van Leeuwen, FE
中科院分区：
文献类型：
--
作者：
Aleman, BMP;van den Belt-Dusebout, AW;van Leeuwen, FE
目的：评估年轻霍奇金病 (HD) 患者的长期特定原因死亡率。患者和方法：研究人群包括 1,261 名在 1965 年至 1987 年间在 41 岁之前接受 HD 治疗的患者。随访直至 2000 年 10 月才完成。对于 95% 的死亡，死因是已知的。将长期原因特异性死亡率与一般人群死亡率进行比较，以评估死亡的相对风险 (RR) 和绝对超额风险 (AER)。 结果：中位随访 17.8 年后，534 名患者死亡（HD 的 55%）。除 HD 之外的所有原因导致的死亡的 RR 是一般人群的 6.8 倍，30 多年后仍达到 5.1。实体瘤 (ST) 和心血管疾病 (CVD) 导致的死亡 RR 总体上有所增加（RR 分别为 6.6 和 6.3），尤其是在 21 岁之前接受治疗的患者中（RR 分别为 14.8 和 13.6）。当这些患者年龄增长时，这种升高的死亡率就会下降。在整个随访过程中，HD 以外原因导致的死亡的总体 AER 有所增加。与仅接受初始治疗的患者相比，接受挽救性化疗的患者因 ST 死亡的 RR 显着增加。结论：HD 患者的主要死亡原因是淋巴瘤，但 20 年后，HD 死亡率可以忽略不计。 10 年后，第二原发癌 (SC) 和 CVD 死亡的 RR 和 AER 继续增加。即使在诊断后 30 多年，HD 患者因 HD 以外的所有原因死亡的风险仍然升高。研究发现，SC 和 CVD 死亡风险增加，特别是在 21 岁之前接受治疗的患者中，但这些风险似乎随着年龄的增长而减弱。 (C) 2003 年，美国临床肿瘤学会。
Purpose : To assess long-term cause-specific mortality of young Hodgkin's disease (HD) patients.Patients and Methods: The study population consisted of 1,261 patients treated for HD before age 41 between 1965 and 1987. Follow-up was complete until October 2000. For 95% of deaths, the cause was known. Long-term cause-specific mortality was compared with general population rates to assess relative risk (RR) and absolute excess risk (AER) of death.Results: After a median follow-up of 17.8 years, 534 patients had died (55% of HD). The RR of death from all causes other than HD was 6.8 times that of the general population, and still amounted to 5.1 after more than 30 years. RRs of death resulting from solid tumors (STs) and cardiovascular disease (CVD) were increased overall (RR = 6.6 and 6.3, respectively), but especially in patients treated before age 21 (RR = 14.8 and 13.6, respectively). When these patients grew older, this elevated mortality decreased. The overall AER of death from causes other than HD increased throughout follow-up. Patients receiving salvage chemotherapy had a significantly increased RR of death from STs, compared to patients receiving initial therapy only.Conclusion: The main cause of death among HD patients was lymphoma, but after 20 years, HD mortality was negligible. The RRs and AERs of death from second primary cancers (SCs) and CVDs continued to increase after 10 years. Even more than 30 years after diagnosis, HD patients experienced elevated risk of death from all causes other than HD. Increased risk of death from SCs and CVDs was found especially in patients treated before age 21, but these risks seemed to abate with age. (C) 2003 by American Society of Clinical Oncology.