Occurrence of Multiple Subsequent Neoplasms in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Occurrence of Multiple Subsequent Neoplasms in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
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DOI：
10.1200/jco.2011.34.6585
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发表时间：
2011-08-01
影响因子：
45.3
通讯作者：
Robison, Leslie L.
中科院分区：
文献类型：
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作者：
Armstrong, Gregory T.;Liu, Wei;Robison, Leslie L.
儿童癌症幸存者经历了后续肿瘤（SN）的发病率增加。第一个SN（SN 1）的幸存者仍然有发展多个SN的风险。由于SNs是一个常见的原因，晚期发病率和死亡率，表征率的多个SNs是need.Patients和MethodsIn共14,358 5年的生存儿童癌症诊断1970年至1986年之间，进行了分析，1,382名幸存者与SN 1。第二个后续肿瘤（SN 2），无论是恶性或良性，累积发病率calculated.ResultsA共1,382幸存者（9.6%）开发SN 1，其中386（27.9%）开发SN 2。在SN 2的患者中，153例（39.6%）发生了两个以上的SN。SN 1后20年时，SN 2的累积发生率为46.9%（95% CI，41.6%-52.2%）。在15年时，放射暴露幸存者中SN 2的累积发生率为41.3%（95% CI，37.2%至45.4%），而未接受放射治疗的幸存者为25.7%（95% CI，16.5%至34.9%）。发生SN 1非黑色素瘤皮肤癌（NMSC）的辐射暴露幸存者随后恶性肿瘤的累积发生率（SMN;即，恶性肿瘤（不包括NMSC）为20.3%（95% CI，13.0%-27.6%），而15年时仅为10.7%（95%CI，7.2%至14.2%）的那些谁暴露于辐射，其SN 1是一个侵入性SMN（不包括NMSC）。NMSC的SN 1鉴定了侵袭性SMN的高风险人群。未暴露于辐射的发生多个SN的幸存者代表了研究肿瘤遗传易感性的目标人群。J Clin Oncol 29：3056-3064. (C)2011年美国临床肿瘤学会
PurposeChildhood cancer survivors experience an increased incidence of subsequent neoplasms (SNs). Those surviving the first SN (SN1) remain at risk to develop multiple SNs. Because SNs are a common cause of late morbidity and mortality, characterization of rates of multiple SNs is needed.Patients and MethodsIn a total of 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, analyses were carried out among 1,382 survivors with an SN1. Cumulative incidence of second subsequent neoplasm (SN2), either malignant or benign, was calculated.ResultsA total of 1,382 survivors (9.6%) developed SN1, of whom 386 (27.9%) developed SN2. Of those with SN2, 153 (39.6%) developed more than two SNs. Cumulative incidence of SN2 was 46.9% (95% CI, 41.6% to 52.2%) at 20 years after SN1. The cumulative incidence of SN2 among radiation-exposed survivors was 41.3% (95% CI, 37.2% to 45.4%) at 15 years compared with 25.7% (95% CI, 16.5% to 34.9%) for those not treated with radiation. Radiation-exposed survivors who developed an SN1 of nonmelanoma skin cancer (NMSC) had a cumulative incidence of subsequent malignant neoplasm (SMN; ie, malignancies excluding NMSC) of 20.3% (95% CI, 13.0% to 27.6%) at 15 years compared with only 10.7% (95% CI, 7.2% to 14.2%) for those who were exposed to radiation and whose SN1 was an invasive SMN (excluding NMSC).ConclusionMultiple SNs are common among aging survivors of childhood cancer. SN1 of NMSC identifies a population at high risk for invasive SMN. Survivors not exposed to radiation who develop multiple SNs represent a population of interest for studying genetic susceptibility to neoplasia. J Clin Oncol 29: 3056-3064. (C) 2011 by American Society of Clinical Oncology