High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin's disease: Report from the late effects study group
High risk of subsequent neoplasms continues with extended follow-up of childhood Hodgkin's disease: Report from the late effects study group
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DOI：
10.1200/jco.2003.11.059
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发表时间：
2003-12-01
影响因子：
45.3
通讯作者：
Meadows, AT
中科院分区：
文献类型：
--
作者：
Bhatia, S;Yasui, Y;Meadows, AT
目的：我们对先前报道的晚期效应研究组队列进行了更新，该队列纳入了1955年至1986年间诊断为16岁或以下的霍奇金病（HD）患儿1380例。我们描述的模式和发生率的后续肿瘤（SNs）发生与延长随访。患者和方法：诊断为HD的中位年龄为11.7岁（范围0.3 ~ 16.9岁），最后随访为27.8岁。中位随访时间为17.0年。结果：确定了103个SNs（总SNs = 212）。与一般人群相比，该队列发生SNs的风险增加18.5倍（标准化发病率[SIR]， 18.5, 95% CI， 15.6至21.7）。第二种恶性肿瘤的累积发病率在20岁时为10.6%，在30岁时增加到26.3%；实性恶性肿瘤20岁时为7.3%，30岁时为23.5%。乳腺癌是最常见的实体恶性肿瘤（SIR, 56.7）。其他常见的实体恶性肿瘤包括甲状腺癌（SIR, 36.4）、骨肿瘤（SIR, 37.1）、结直肠癌（SIR, 36.4）、肺癌（SIR, 27.3）和胃癌（SIR, 63.9）。实体瘤的危险因素包括HD患者年龄小和放射治疗。32例患者发生第三次肿瘤，在诊断为第二次恶性肿瘤后10年的累积发病率接近21%。结论：对这一大批HD幸存者的进一步随访表明，已知辐射相关实体瘤（乳腺癌和甲状腺癌）以及成人常见上皮肿瘤（结肠癌和肺癌）的出现年龄比一般人群预期的要小，因此有必要对这一高风险人群进行持续监测。(C) 2003年由美国临床肿瘤学会出版。
Purpose: We present an update of a previously reported Late Effects Study Group cohort of 1,380 children with Hodgkin's disease (HD) diagnosed between 1955 and 1986 in patients aged 16 years or younger. We describe the pattern and incidence of subsequent neoplasms (SNs) occurring with extended follow-up.Patients and Methods: Median age at diagnosis of HD was 11.7 years (range, 0.3 to 16.9 years) and at last follow-up was 27.8 years. Median length of follow-up was 17.0 years.Results: An additional 103 SNs were ascertained (total SNs = 212). The cohort was at an 18.5-fold increased risk of developing SNs compared with the general population (standardized incidence ratio [SIR], 18.5, 95% CI, 15.6 to 21.7). The cumulative incidence of any second malignancy was 10.6% at 20 years, increasing to 26.3% at 30 years; and of solid malignancies was 7.3% at 20 years, increasing to 23.5% at 30 years. Breast cancer was the most common solid malignancy (SIR, 56.7). Other commonly occurring solid malignancies included thyroid cancer (SIR, 36.4), bone tumors (SIR, 37.1), and colorectal (SIR, 36.4), lung (SIR, 27.3), and gastric cancers (SIR, 63.9). Risk factors for solid tumors included young age at HD and radiation-based therapy. Thirty-two patients developed third neoplasms, with the cumulative incidence approaching 21% at 10 years from diagnosis of second malignancy.Conclusion: Additional follow-up of this large cohort of HD survivors documents an increasing occurrence of known radiation-associated solid tumors, (breast and thyroid cancers), as well as emergence of epithelial neoplasms common in adults, (colon and lung cancers) at a younger age than expected in the general population, necessitating ongoing surveillance of this high risk population. (C) 2003 by American Society of Clinical Oncology.