Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study
Assessment of primary cancers in GH-treated adult hypopituitary patients: an analysis from the Hypopituitary Control and Complications Study
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DOI：
10.1530/eje-11-0286
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发表时间：
2011-08-01
影响因子：
5.8
通讯作者：
Robison, Leslie L.
中科院分区：
文献类型：
--
作者：
Child, Christopher J.;Zimmermann, Alan G.;Robison, Leslie L.
目的：GH 和 IGF 具有促有丝分裂特性，引起人们猜测 GH 治疗可能会增加恶性肿瘤风险。虽然对 GH 治疗的儿童癌症幸存者的研究表明二次肿瘤略有增加，但对 GH 治疗的成人的研究却模棱两可。 设计：在垂体下控制和并发症研究药物流行病学数据库中，对 6840 名接受 GH 治疗和 940 名未接受 GH 治疗的成人患者的新发癌症和二次癌症的发病率进行了评估。方法：在主要分析中评估了明显的癌症病例，敏感性分析包括可能和可能的情况癌症。使用美国的监测、流行病学和最终结果以及所有其他国家的 GLOBOCAN 计算癌症的标准化发病率 (SIR)。结果：在对接受 GH 治疗的患者进行 3.7 年的平均随访期间，发现了 142 例明显的癌症病例，总体 SIR 为 0.88（95% 置信区间 (CI) 0.74-1.04）；对于每个被检查的国家，95% CI 的值为 1.0。来自美国的接受 GH 治疗的患者（71 例）的 SIR 为 0.94（95% CI 0.73-1.18），来自美国的未接受 GH 治疗的患者（27 例）的 SIR 为 1.16（95% CI 0.76-1.69）。对于年龄 < 35 岁的美国接受 GH 治疗的患者，SIR（6 例）为 3.79 (1.39-8.26)，所有其他年龄组的 SIR 均未升高；来自美国的儿童期发病 (CO) GH 缺乏症 (GHD) 患者的 SIR 为 2.74 (95% CI 1.18-5.41)。接受 GH 治疗的患者（11 例）结直肠癌的 SIR 为 0.60（95% CI 0.30-1.08）。结论：在相对较短的随访期内，6840 名接受 GH 的成人患者的总体原发癌症风险并未增加。在美国队列中，按年龄 < 35 岁或 CO GHD 定义的亚组中发现 SIR 升高。
Objective: GH and IGFs have mitogenic properties, causing speculation that GH treatment could increase risk of malignancy. While studies in GH-treated childhood cancer survivors have suggested a slight increase in second neoplasms, studies in GH-treated adults have been equivocal.Design: Incidence of de novo and second cancers was evaluated in 6840 GH-treated and 940 non GH-treated adult patients in the Hypopituitary Control and Complications Study pharmacoepidemiological database.Methods: Evident cancer cases were evaluated in the main analysis, with sensitivity analyses including probable and possible cancers. Standardized incidence ratios (SIRs) for cancers were calculated using Surveillance, Epidemiology and EndResults for the USA and GLOBOCAN for all other countries. Results: During the mean follow-up of 3.7 years/GH-treated patient, 142 evident cancer cases were identified, giving an overall SIR of 0.88 (95% confidence interval (CI) 0.74-1.04); 95% CIs included the value of 1.0 for each country examined. The SIR for GH-treated patients from the USA (71 cases) was 0.94 (95% CI 0.73-1.18), and for non GH-treated patients from the USA (27 cases) was 1.16 (95% CI 0.76-1.69). For GH-treated patients from the USA aged < 35 years, the SIR (six cases) was 3.79 (1.39-8.26), with SIR not elevated for all other age categories; SIR for patients from the USA with childhood onset (CO) GH deficiency (GHD) was 2.74 (95% CI 1.18-5.41). The SIR for colorectal cancer in GH-treated patients (11 cases) was 0.60 (95% CI 0.30-1.08).Conclusions: With relatively short follow-up, the overall primary cancer risk in 6840 patients receiving GH as adults was not increased. Elevated SIRs were found for subgroups in the USA cohort defined by age < 35 years or CO GHD.