Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation:: An EBMT late effects working party study
Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation:: An EBMT late effects working party study
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DOI：
10.1200/jco.2006.08.9276
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发表时间：
2007-06-10
影响因子：
45.3
通讯作者：
Socie, Gerard
中科院分区：
文献类型：
--
作者：
Cohen, Amnon;Rovelli, Attilio;Socie, Gerard
目的：需要在大规模人群中确定造血干细胞移植（HSCT）对甲状腺癌发生的影响。本研究评估的发病率和危险因素，导致继发性甲状腺癌（STC）的患者接受transplantation.Patients和方法，我们进行了一项回顾性调查研究，通过两步问卷的方式从166个中心谁回答，和数据报告的欧洲血液和骨髓移植组（EBMT）登记册上的移植活动的数据进行比较。在随访期间（1985年至2003年），在EBMT队列的68，936例接受移植的患者中发现了32例STC。然后，这些患者进行了比较，年龄和性别特异性发病率在欧洲人口和风险因素STC进行了analysed.Results的标准化发病率比（SIRS）STC在接受移植的人口为3.26，与欧洲人口相比。多变量分析显示，移植时年龄小是STC最强的危险因素（相对危险度[RR]，0至10岁为24.61; 11至20岁为4.80）。其他危险因素包括放射治疗（RR，3.44）、女性（RR，2.79）和慢性移植物抗宿主病（RR，2.94）。9例患者在诊断时未显示甲状腺疾病的临床体征。全甲状腺切除术和碘消融术是大多数患者的标准治疗方法，只有1例患者死于STC进展。这些结果应促进HSCT后继发性甲状腺癌的早期发现和治疗指南的筛查工作，特别是在儿童和青少年期间接受移植的患者。
Purpose The effects of hematopoietic stem-cell transplantation (HSCT) on thyroid carcinogenesis needs to be determined in a large population. This study evaluates the incidence and the risk factors contributing to secondary thyroid carcinoma (STC) in patients who receive transplantation.Patients and Methods We performed a retrospective investigational study, comparing data obtained by means of a two-step questionnaire from the 166 centers who replied, and data reported to the European Group for Blood and Marrow Transplantation (EBMT) registry on their transplantation activity. During the follow-up period (1985 to 2003), 32 instances of STC were found within the EBMT cohort of 68,936 patients who received transplants. These patients were then compared with age- and sex-specific incidence rates in the European population and risk factors for STC were analyzed.Results The standardized incidence ratios (SIRs) of STC in the population who underwent transplantation was 3.26, in comparison with the European population. Multivariate analysis revealed that young age at transplantation was the strongest risk factor for STC (relative risk [RR], 24.61 for age 0 to 10 years; RR, 4.80 for age 11 to 20). Other risk factors were irradiation (RR, 3.44), female sex (RR, 2.79), and chronic graft-versus-host disease (RR, 2.94). Nine patients showed no clinical signs of thyroid illness at diagnosis. Total thyroidectomy and iodine ablation was the standard treatment for the majority of patients, and only one patient died due to STC progression.Conclusion Long-term survivors of HSCT are at risk for STCs. These results should promote efforts in screening for early detection and treatment guidelines of secondary thyroid cancer after HSCT, especially in patients who receive transplants during childhood and adolescence.