Second malignant neoplasms among long-term survivors of Hodgkin's disease: A population-based evaluation over 25 years
Second malignant neoplasms among long-term survivors of Hodgkin's disease: A population-based evaluation over 25 years
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DOI：
10.1200/jco.2002.09.038
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发表时间：
2002-08-15
影响因子：
45.3
通讯作者：
Travis, LB
中科院分区：
文献类型：
--
作者：
Dores, GM;Metayer, C;Travis, LB
目的：量化霍奇金病(HD)长期存活者中特定部位继发癌症，特别是实体瘤的相对和绝对超额风险，并根据确诊时的年龄、达到的年龄和首次治疗以来的时间评估风险。患者和方法：对北美和欧洲16个基于人群的癌症登记报告的32,591例HD患者(1,111名25年存活者)的数据进行分析。95%可信区间[CI]=2.2~2.4)，包括1,726个实体瘤(O/E=2.0；95%CI，1.9~2.0)。肺癌(Obs=377，O/E=2.9)、消化道癌(Obs 376；O/E=1.7)和女性乳腺癌(Obs=234；O/E=2.0)在随后的恶性肿瘤中数量最多。HD诊断25年后，发生实体瘤的精算风险为21.9%。HD诊断时实体瘤的相对危险度随着年龄的增加而降低，但5 1~60岁HD诊断患者的癌症负担最高(AER=79.2/10,000例/年)。在所有实体肿瘤的相对风险和AER随着时间的推移而逐渐上升之后，25年的风险明显下降。食道癌、胃癌、直肠癌、女性乳腺癌、膀胱癌、甲状腺癌和骨/结缔组织癌的时间趋势和治疗组分布提示了放射致癌效应。结论：所有HD年龄组的继发癌风险均显著增加。尽管胃癌、女性乳腺癌和子宫颈癌的风险显著升高持续了25年，但其他部位实体肿瘤的相对风险和AER明显降低。(C)2002年，由美国临床肿瘤学会提供。
Purpose: To quantify the relative and absolute excess risks (AER) of site-specific second cancers, in particular solid tumors, among long-term survivors of Hodgkin's disease (HD) and to assess risks according to age at HD diagnosis, attained age, and time since initial treatment.Patients and Methods: Data from 32,591 HD patients (1,111 25-year survivors) reported to 16 population-based cancer registries in North America and Europe (1935 to 1994) were analyzed.Results: Two thousand one hundred fifty-three second cancers (observed-to-expected ratio [O/E] = 2.3; 95% confidence interval [CI] = 2.2 to 2.4), including 1,726 solid tumors (O/E = 2.0; 95% CI, 1.9 to 2.0) were reported. Cancers of the lung (observed [Obs] = 377, O/E = 2.9), digestive tract (Obs 376; O/E = 1.7), and female breast (Obs = 234; O/E 2.0) accounted for the largest number of subsequent malignancies. Twenty-five years after HD diagnosis, the actuarial risk of developing a solid tumor was 21.9%. The relative risk of solid neoplasms decreased with increasing age at HD diagnosis, however, patients aged 5 1 to 60 years at HD diagnosis sustained the highest cancer burden (AER = 79.2/10,000 patients/year). After a progressive rise in relative risk and AER of all solid tumors over time, there was an apparent downturn in risk at 25 years. Temporal trends and treatment group distribution for cancers of the esophagus, stomach, rectum, female breast, bladder, thyroid, and bone/connective tissue were suggestive of a radiogenic effect.Conclusion: Significantly increased risks of second cancers were observed in all HD age groups. Although significantly elevated risks of stomach, female breast, and uterine cervix cancers persisted for 25 years, an apparent decrease in relative risk and AER of solid tumors at other sites is suggested. (C) 2002 by American Society of Clinical Oncology.