Risk of cancer in children with AIDS
Risk of cancer in children with AIDS
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DOI：
10.1001/jama.284.2.205
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发表时间：
2000-07-12
影响因子：
120.7
通讯作者：
Goedert, JJ
中科院分区：
文献类型：
--
作者：
Biggar, RJ;Frisch, M;Goedert, JJ
研究背景：缺乏儿童获得性免疫缺陷综合征（AIDS）相关癌症的人群基础数据，目的：确定儿童AIDS相关癌症的风险。设计、设置和参与者使用1978年至1996年美国11个地点不同时期的记录，我们将艾滋病诊断时年龄在14岁及以下的儿童的数据与当地癌症登记数据联系起来。主要结果测量癌症频率，在艾滋病发病后2年内，癌症发病率和相对危险度（RR;结果在4954例艾滋病儿童中，124例（12.4%）为非典型性艾滋病，12.4%（12.4%）为非典型性艾滋病，12.4%（12.4%）为非典型性艾滋病。（2.5%）在艾滋病发病前、发病时或发病后被确诊为癌症，其中非霍奇金淋巴瘤（NHL）100例，卡波西肉瘤（KS）8例，平滑肌肉瘤4例，霍奇金病2例;其他或未指明的癌症10例。根据人口比率（使用特定地区的登记数据），研究样本中确定的所有癌症的预期数量均小于1。在艾滋病诊断后的前2年（5485人-年），NHL发病率为510/10万人-年（RR，651; 95%置信区间[CI]，432-941）。AIDS诊断后发生NHL的中位时间为14个月（范围，3-107个月）。最常见的NHL类型是伯基特淋巴瘤。然而，原发性脑淋巴瘤的风险（91/10万人-年）特别高（RR，7143; 95%CI，2321-16692），4例患者在AIDS发病后超过2年（范围，37-98个月）被诊断。平滑肌瘤也倾向于发生在艾滋病发病后数年，4例中有3例发生在艾滋病诊断后33至76个月，而KS仅在艾滋病诊断时或2年内报告。霍奇金病的风险也显着增加（RR，62; 95%CI，2-342）。结论艾滋病相关的儿科癌症的频谱类似于成人中看到的，另外平滑肌肉瘤。原发性脑淋巴瘤和平滑肌瘤往往发生在艾滋病发病后存活数年的儿童中。由于该人群中这些癌症的预期数量小于1，并且由于观察到的某些类型的癌症数量较少，因此RR估计值不精确，在解释时需要谨慎。
Context Population-based data on cancers associated with acquired immunodeficiency syndrome (AIDS) in children are lacking.Objective To determine risk of pediatric AIDS-associated cancers.Design, Setting, and Participants Using records from 11 locations in the United States for varying periods between 1978 and 1996, we linked data for children aged 14 years and younger at AIDS diagnosis to local cancer registry data.Main Outcome Measures Cancer frequency and, in the 2-year post-AIDS onset period, cancer incidence and relative risk (RR; measured as standardized incidence ratio), by cancer type.Results Among 4954 children with AIDS, 124 (2.5%) were identified as having cancer before, at, or after AIDS onset, including 100 cases of non-Hodgkin lymphoma (NHL), 8 of Kaposi sarcoma (KS), 4 of leiomyosarcoma, and 2 of Hodgkin disease; there were 10 other or unspecified cancers. Expected numbers for all cancers identified in the study sample, based on population rates (using area-specific registry data), were less than 1. In the first 2 years after AIDS diagnosis (5485 person-years), NHL incidence was 510 per 100 000 person-years (RR, 651; 95% confidence interval [CI], 432-941). Median time for developing NHL after AIDS diagnosis was 14 months (range, 3-107 months). The most common type of NHL was Burkitt lymphoma. However, the risk of primary brain lymphoma (91 per 100 000 person-years) was especially high (RR, 7143; 95% CI, 2321-16692), and 4 cases were diagnosed more than 2 years (range, 37-98 months) after AIDS onset. Leiomyosarcomas also tended to occur several years after AIDS onset, with 3 of the 4 cases occurring 33 to 76 months after AIDS diagnosis, whereas KS was reported only at or within 2 years of AIDS diagnosis. Hodgkin disease risk was also significantly increased (RR, 62; 95% CI, 2-342).Conclusions The spectrum of AIDS-associated pediatric cancers resembled that seen in adults, with the addition of leiomyosarcoma. Both primary brain lymphomas and leiomyosarcomas tended to occur in children surviving several years after AIDS onset. Because the expected numbers of these cancers in this population were less than 1 and because of the small numbers of some types of observed cancers, the RR estimates are imprecise and caution is warranted in their interpretation.