Late and very late mortality in 5-year survivors of childhood cancer: Changing pattern over four decades-Experience from the Nordic countries
Late and very late mortality in 5-year survivors of childhood cancer: Changing pattern over four decades-Experience from the Nordic countries
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DOI：
10.1002/ijc.27393
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发表时间：
2012-10-01
影响因子：
6.4
通讯作者：
Moller, Torgil R.
中科院分区：
文献类型：
--
作者：
Garwicz, Stanislaw;Anderson, Harald;Moller, Torgil R.
儿童癌症长期幸存者的死亡率高于一般人群。在这里，我们评估了北欧五个国家40年间诊断出的儿童和青少年癌症后5年幸存者的晚期和极晚期死亡率，以及死亡原因的模式。该研究以人群为基础，使用了全国癌症登记和死亡原因登记的数据。在1960年至1999年间，总共有37,515例在20岁之前被诊断为癌症的病例。死亡率分析中使用的5年幸存者队列包括21984例患者，随访至2005年12月31日（挪威、瑞典）或2006年（丹麦、芬兰、冰岛）。在最近的随访中，有2324名患者死亡。总体标准化死亡率为8.3，绝对超额风险为每1000人年6.2。死亡原因的模式在不同的原发性癌症诊断组之间有显著差异，并且高度依赖于诊断后经过的时间。随着随访时间的缩短，因原发癌症导致的死亡率主要增加，而随着随访时间的延长，因第二癌和非癌症原因导致的死亡率增加。在最近一段时间（1990 - 1999年）接受治疗的患者中，诊断后5至10年的死亡率与之前的时期相比继续下降，而10年后的死亡率随时间变化很小。我们得出结论，明确生存的改善不仅需要降低早期死亡率，而且需要降低晚期死亡率和极晚期死亡率。
Long-term survivors of childhood cancer suffer from a higher mortality than the general population. Here we evaluate late and very late mortality, and patterns of causes of death, in 5-year survivors after childhood and adolescent cancer in cases diagnosed during four decades in the five Nordic countries. The study is population-based and uses data of the nationwide cancer registries and the cause of death registers. There were in all 37,515 incident cases, diagnosed with cancer before the age of 20 years, between 1960 and 1999. The 5-year survivor cohort used in the mortality analyses consisted of 21,984 patients who were followed up for vital status until December 31, 2005 (Norway, Sweden) or 2006 (Denmark, Finland, Iceland). At the latest follow-up, 2,324 patients were dead. The overall standardized mortality ratio was 8.3 and the absolute excess risk was 6.2 per 1,000 person-years. The pattern of causes of death varied markedly between different groups of primary cancer diagnosis, and was highly dependent on time passed since diagnosis. With shorter follow-up the mortality was mainly due to primary cancer, while with longer follow-up, mortality due to second cancer and noncancer causes became more prominent. Mortality between 5 and 10 years after diagnosis continued to decrease in patients treated during the most recent period of time, 19901999, compared to previous periods, while mortality after 10 years changed very little with time period. We conclude that improvement of definite survival demands not only reducing early but also late and very late mortality.