Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort
Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort
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DOI：
10.1200/jco.2008.21.1920
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发表时间：
2009-05-10
影响因子：
45.3
通讯作者：
Inskip, Peter D.
中科院分区：
文献类型：
--
作者：
Meadows, Anna T.;Friedman, Debra L.;Inskip, Peter D.
目的 回顾儿童癌症幸存者研究（CCSS）队列中截至2006年1月1日报告且在2008年7月31日前发表的后续肿瘤（SNs）相关报告，并讨论与SNs相关的宿主、疾病和治疗相关风险因素。
患者与方法 SNs通过幸存者自我报告确定，随后经病理结果或病历审查确认。计算了第二恶性肿瘤（SMNs）的累积发病率和标准化发病比。通过泊松回归评估宿主、疾病和治疗相关风险因素的影响。
结果 在14358名队列成员中，730人报告了802例SMNs（不包括非黑色素瘤皮肤癌）。这比7年前对CCSS队列中SMNs的首次综合分析所报告的数量增加了2.3倍。此外，还诊断出66例脑膜瘤和1007例非黑色素瘤皮肤癌。SMNs的30年累积发病率为9.3%，非黑色素瘤皮肤癌为6.9%。对于所有儿童期原发性癌症诊断，随访超过20年时SNs的风险仍然升高。在多变量分析中，风险因SN亚型而异，但包括放疗、诊断时年龄、性别、癌症家族史以及儿童期原发性癌症诊断。儿童期原发性癌症诊断为霍奇金淋巴瘤或肉瘤且接受放疗的女性幸存者风险尤其增加。对与放疗相关风险的分析表明，特定SNs具有不同的剂量 - 反应曲线。
结论 儿童癌症幸存者发生SNs（包括非黑色素瘤皮肤癌和脑膜瘤）的风险较高且呈上升趋势。医疗保健专业人员应了解这些风险的程度，以便为个体提供适当的咨询和随访。
Purpose To review the reports of subsequent neoplasms (SNs) in the Childhood Cancer Survivor Study (CCSS) cohort that were made through January 1, 2006, and published before July 31, 2008, and to discuss the host-, disease-, and therapy-related risk factors associated with SNs.Patients and Methods SNs were ascertained by survivor self-reports and subsequently confirmed by pathology findings or medical record review. Cumulative incidence of SNs and standardized incidence ratios for second malignant neoplasms (SMNs) were calculated. The impact of host-, disease-, and therapy-related risk factors was evaluated by Poisson regression.Results Among 14,358 cohort members, 730 reported 802 SMNs (excluding nonmelanoma skin cancers). This represents a 2.3-fold increase in the number of SMNs over that reported in the first comprehensive analysis of SMNs in the CCSS cohort, which was done 7 years ago. In addition, 66 cases of meningioma and 1,007 cases of nonmelanoma skin cancer were diagnosed. The 30-year cumulative incidence of SMNs was 9.3% and that of nonmelanoma skin cancer was 6.9%. Risk of SNs remains elevated for more than 20 years of follow-up for all primary childhood cancer diagnoses. In multivariate analyses, risks differ by SN subtype, but include radiotherapy, age at diagnosis, sex, family history of cancer, and primary childhood cancer diagnosis. Female survivors whose primary childhood cancer diagnosis was Hodgkin's lymphoma or sarcoma and who received radiotherapy are at particularly increased risk. Analyses of risk associated with radiotherapy demonstrated different dose-response curves for specific SNs.Conclusion Childhood cancer survivors are at a substantial and increasing risk for SNs, including nonmelanoma skin cancer and meningiomas. Health care professionals should understand the magnitude of these risks to provide individuals with appropriate counseling and follow-up.