Lifelong Cancer Incidence in 47 697 Patients Treated for Childhood Cancer in the Nordic Countries
Lifelong Cancer Incidence in 47 697 Patients Treated for Childhood Cancer in the Nordic Countries
复制标题
DOI：
10.1093/jnci/djp104
复制
发表时间：
2009-06-02
影响因子：
10.3
通讯作者：
Garwicz, Stanislaw
中科院分区：
文献类型：
--
作者：
Olsen, Jorgen H.;Moller, Torgil;Garwicz, Stanislaw
儿童期癌症长期存活者的癌症模式尚未得到全面调查，我们获得了一个队列，其中包括47697名0-19岁的儿童和青少年癌症患者，这些癌症患者由丹麦、芬兰、冰岛、挪威和瑞典在1943-2005年期间的全国癌症登记处定义。队列成员随访至79岁，随后通知登记处的原发性癌症，并使用国家和性别标准化发病率（SIR）将幸存者的年龄特异性风险模式与全国人群的风险模式进行比较。我们使用乘性泊松回归模型来估计达到年龄的癌症相对风险，并对日历期间和原发性癌症诊断年龄进行调整。我们还计算了归因于儿童癌症幸存者身份的超额绝对风险（ESTA），并确定了第二原发性癌症的累积发病率作为三个亚组（按儿童癌症治疗期定义）达到年龄的函数。得出总体SIR为3.3（95%置信区间= 3.1至3.5）。在所有年龄组中，即使是接近70岁的队列成员，相对风险也在统计学上显著增加。幸存者中第二原发性癌症的发病率从生命早期的每1000人年观察增加1例，逐渐增加到60-69岁年龄组的每1000人年观察增加6例。对于在化疗前（1943-1959）接受治疗的儿童，第二原发癌的累积风险在60岁、70岁和80岁时分别达到18%、34%和48%。年龄特异性发病率最高的队列成员在密集的，多药化疗的时代（1975-2005年）。儿童癌症的幸存者有一个持续的第二原发性癌症的风险超过他们的生活，伴随着在特定部位的癌症的风险不断变化。
The pattern of cancer in long-term survivors from childhood cancer has not been investigated comprehensively.We obtained a cohort of 47 697 children and adolescents aged 0-19 years with cancer as defined by the country-wide cancer registries of Denmark, Finland, Iceland, Norway, and Sweden during 1943-2005. Cohort members were followed through age 79 years for subsequent primary cancers notified to the registries, and the age-specific risk pattern of the survivors was compared with that of the national populations using country and sex standardized incidence ratios (SIRs). We used a multiplicative Poisson regression model to estimate relative risk of cancer for attained age, with adjustment for calendar period and age at diagnosis of primary cancer. We also calculated excess absolute risk (EAR) attributable to status as childhood cancer survivor and determined the cumulative incidence of second primary cancer as a function of attained age for three subcohorts defined by period of treatment for childhood cancer.A total of 1180 asynchronous second primary cancers were observed in 1088 persons, yielding an overall SIR of 3.3 (95% confidence interval = 3.1 to 3.5). The relative risk was statistically significantly increased in all age groups, even for cohort members approaching 70 years of age. The EAR for second primary cancer among survivors increased gradually from one additional case per 1000 person-years of observation in early life to six additional cases per 1000 person-years in the age group 60-69 years. For children treated in the prechemotherapy era (1943-1959), the cumulative risk for a second primary cancer reached 18%, 34%, and 48% at ages 60, 70, and 80 years, respectively. The age-specific incidence rates were highest for cohort members treated in the era of intensive, multiple-agent chemotherapy (1975-2005).Survivors of childhood cancer have a persistent excess risk for a second primary cancer throughout their lives, accompanied by continuous changes in the risk of cancers at specific sites.