Long-term risk of second malignant neoplasms after neuroblastoma in childhood:: Role of treatment
Long-term risk of second malignant neoplasms after neuroblastoma in childhood:: Role of treatment
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DOI：
10.1002/ijc.11455
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发表时间：
2003-12-10
影响因子：
6.4
通讯作者：
de Vathaire, F
中科院分区：
文献类型：
--
作者：
Rubino, C;Adjadj, E;de Vathaire, F
本研究的目的是量化神经母细胞瘤长期存活者发生第二恶性肿瘤（SMNs）的风险，并研究治疗对该风险的影响。我们研究了1948年至1986年在法国和英国的8个治疗中心的544例16岁以前诊断为神经母细胞瘤的5年生存患者的数据。在平均随访15年（范围，5-38年）后，12名儿童共发生13例SMN，而一般人群发生率预计为1.19例。在这些SMN中，有S甲状腺癌和3例乳腺癌。自神经母细胞瘤诊断以来，随着年龄的增长，SMN的风险增加。在多变量分析中，与放疗相关的SMN的相对风险为4.3（95% CI 0.8-78），而SMN的风险增加与化疗总体给药无关（RR = 0.4，95% CI 0.1-1.9）。在30年的随访中，接受神经母细胞瘤治疗的幼儿发生SMN的风险显著增加。放疗治疗被认为是一个重要的风险因素，发展SMN，而化疗没有效果的证据。虽然我们的研究结果反映了过去治疗方式的晚期效应，但它们强调了对神经母细胞瘤治疗的幼儿进行长期监测的重要性。对于这些患者，需要更多年的随访，以了解其治疗相关SMN的总体风险。(C)2003年威利-利斯。Inc.
The aim of our study was to quantify the risk of second malignant neoplasms (SMNs) among long-term survivors of neuroblastoma and to study the influence of treatment on this risk. We studied data from 544 5-year survival patients diagnosed with neuroblastoma before age 16 years at 8 French and British treatment centres from 1948 to 1986. After an average follow-up of 15 years (range, 5-38 years), 12 children developed a total of 13 SMNs, whereas 1.19 were expected from general population rates. Among these SMNs, there were S thyroid and 3 breast cancers. Increases of the risks of SMN were observed with time since neuroblastoma diagnosis and attained age. In a multivariate analysis, the relative risk of SMN associated with radiotherapy was 4.3 (95% CI 0.8-78), whereas no increased risk of SMN was associated with the administration of chemotherapy as a whole (RR = 0.4, 95% CI 0.1-1.9). Young children treated for a neuroblastoma have significantly increased risks of SMN over 3 decades of follow-up. Radiotherapy treatment was found to be an important risk factor for developing SMNs, whereas no effect of chemotherapy was evidenced. Although our findings reflect the late effects of past therapeutic modalities, they underscore the importance of long-term surveillance of young children treated for a neuroblastoma. For these patients, many more years of follow-up are required to appreciate their overall risks of treatment-related SMNs. (C) 2003 Wiley-Liss. Inc.