Secondary cancers after a childhood cancer diagnosis: a nationwide hospital-based retrospective cohort study in Japan
Secondary cancers after a childhood cancer diagnosis: a nationwide hospital-based retrospective cohort study in Japan
复制标题
DOI：
10.1007/s10147-015-0927-z
复制
发表时间：
2016-06-01
影响因子：
3.3
通讯作者：
Kuroda, Tatsuo
中科院分区：
文献类型：
--
作者：
Ishida, Yasushi;Qiu, Dongmei;Kuroda, Tatsuo
在亚洲国家，儿童癌症幸存者继发性癌症的流行病学尚不清楚。本研究通过在日本全国范围内进行的调查，对1980年至2009年期间诊断为癌症的10,069名儿童进行了回顾性队列研究，旨在评估继发性癌症的发病率和危险因素。以死亡作为竞争风险计算累积发病率，并采用灰色方法进行比较。标准化发病率（SIR）定义为观察到的癌症数量除以预期癌症数量的比值。风险因素采用考克斯回归分析，128例患者（1.3%）在中位随访8.4年内发生继发性癌症。初次癌症诊断后10年的累积发病率为1.1%（95%置信区间[CI] 0.9-1.4），20年为2.6%（95% CI 2.1-3.3）。仅限于5年存活者（n = 5，387）的敏感性分析证实了这些低发生率。继发癌的SIR为12.1（95%CI 10.1-14.4）.在考克斯分析中，继发性癌症的风险比为3.81（95% CI 1.53-9.47）视网膜母细胞瘤，2.78骨/软组织肉瘤（95% CI 1.44-5.38）和1.81（95% CI 1. 16 - 2. 83）为异基因干细胞移植。日本儿童继发性癌症累积发病率不高;但SIR相对较高。视网膜母细胞瘤或肉瘤以及异基因干细胞移植是继发性癌症的重要危险因素。
The epidemiology of secondary cancers in childhood cancer survivors has been unknown in Asian countries. Our aim is to assess the incidence and risk factors for secondary cancers through a nationwide survey in Japan.A retrospective cohort study comprising 10,069 children who were diagnosed with cancer between 1980 and 2009 was conducted in 15 Japanese hospitals. The cumulative incidence rate was calculated using death as the competing risk and compared by the Gray method. The standardized incidence ratio (SIR) was defined as the ratio of the number of observed cancers divided by the number of expected cancers. The risk factors were analyzed using Cox regression analysis.One hundred and twenty-eight patients (1.3 %) developed secondary cancers within a median follow-up of 8.4 years. The cumulative incidence rate was 1.1 % (95 % confidence interval [CI] 0.9-1.4) at 10 years and 2.6 % (95 % CI 2.1-3.3) at 20 years after primary cancer diagnosis. Sensitivity analysis, limited to 5-year survivors (n = 5,387), confirmed these low incidence rates. The SIR of secondary cancers was 12.1 (95 % CI 10.1-14.4). In the Cox analysis, the hazard ratios for secondary cancers were 3.81 (95 % CI 1.53-9.47) for retinoblastoma, 2.78 (95 % CI 1.44-5.38) for bone/soft tissue sarcomas, and 1.81 (95 % CI 1.16-2.83) for allogeneic stem cell transplantation.The cumulative incidence of secondary cancers in children in Japan was not high; however, the SIR was relatively high. Retinoblastoma or sarcoma in addition to allogeneic stem cell transplantation were significant risk factors for secondary cancers.