Subsequent Neoplasms in 5-Year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study
Subsequent Neoplasms in 5-Year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study
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DOI：
10.1093/jnci/djq238
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发表时间：
2010-07-21
影响因子：
10.3
通讯作者：
Neglia, Joseph P.
中科院分区：
文献类型：
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作者：
Friedman, Debra L.;Whitton, John;Neglia, Joseph P.
后续肿瘤的发生直接影响癌症幸存者的生活数量和质量。我们在儿童癌症幸存者研究（CCSS）中扩大了对这些事件的分析，以更好地了解这些事件随着幸存者人口年龄的增长而发生。在CCSS中，从1970年到1986年接受治疗的14359名5年存活者中位年龄为30岁（范围= 5-56岁）的儿童癌症诊断后5年或更长时间发生后续肿瘤的发生率和风险被确定。在儿童癌症诊断后30年，我们计算了30年后续肿瘤的累积发病率，并通过使用多变量泊松回归计算了侵袭性第二恶性肿瘤的标准化发病率比（SIRs）、超额绝对风险（ear）和后续肿瘤的相对风险。在14359例5年幸存者中，1402例随后发展为2703例肿瘤。儿童期癌症诊断后30年的累积发病率为20.5%(95%可信区间[CI] = 19.1%至21.8%)，第二恶性肿瘤（不包括非黑色素瘤皮肤癌）的累积发病率为7.9% (95% CI = 7.2%至8.5%)，非黑色素瘤皮肤癌的累积发病率为9.1% (95% CI = 8.1%至10.1%)，脑膜瘤的累积发病率为3.1% （95% CI = 2.5%至3.8%）。所有原发性诊断均存在明显的过度风险（EAR = 2.6 / 1000人-年，95% CI = 2.4 - 2.9 / 1000人-年；SIR = 6.0, 95% CI = 5.5 - 6.4），其中最高的是霍奇金淋巴瘤（SIR = 8.7, 95% CI = 7.7 - 9.8）和尤文氏肉瘤（SIR = 8.5, 95% CI = 6.2 - 11.7）。在泊松多变量分析中，女性、诊断年龄较大、治疗时间较早、霍奇金淋巴瘤的诊断和放射治疗与随后的肿瘤风险增加相关。随着儿童癌症幸存者进入成年期，患后续肿瘤的风险增加。幸存的霍奇金淋巴瘤患者风险最大。没有证据表明风险随着随访时间的延长而降低。
The occurrence of subsequent neoplasms has direct impact on the quantity and quality of life in cancer survivors. We have expanded our analysis of these events in the Childhood Cancer Survivor Study (CCSS) to better understand the occurrence of these events as the survivor population ages.The incidence of and risk for subsequent neoplasms occurring 5 years or more after the childhood cancer diagnosis were determined among 14 359 5-year survivors in the CCSS who were treated from 1970 through 1986 and who were at a median age of 30 years (range = 5-56 years) for this analysis. At 30 years after childhood cancer diagnosis, we calculated cumulative incidence at 30 years of subsequent neoplasms and calculated standardized incidence ratios (SIRs), excess absolute risks (EARs) for invasive second malignant neoplasms, and relative risks for subsequent neoplasms by use of multivariable Poisson regression.Among 14 359 5-year survivors, 1402 subsequently developed 2703 neoplasms. Cumulative incidence at 30 years after the childhood cancer diagnosis was 20.5% (95% confidence interval [CI] = 19.1% to 21.8%) for all subsequent neoplasms, 7.9% (95% CI = 7.2% to 8.5%) for second malignant neoplasms (excluding nonmelanoma skin cancer), 9.1% (95% CI = 8.1% to 10.1%) for nonmelanoma skin cancer, and 3.1% (95% CI = 2.5% to 3.8%) for meningioma. Excess risk was evident for all primary diagnoses (EAR = 2.6 per 1000 person-years, 95% CI = 2.4 to 2.9 per 1000 person-years; SIR = 6.0, 95% CI = 5.5 to 6.4), with the highest being for Hodgkin lymphoma (SIR = 8.7, 95% CI = 7.7 to 9.8) and Ewing sarcoma (SIR = 8.5, 95% CI = 6.2 to 11.7). In the Poisson multivariable analysis, female sex, older age at diagnosis, earlier treatment era, diagnosis of Hodgkin lymphoma, and treatment with radiation therapy were associated with increased risk of subsequent neoplasm.As childhood cancer survivors progress through adulthood, risk of subsequent neoplasms increases. Patients surviving Hodgkin lymphoma are at greatest risk. There is no evidence of risk reduction with increasing duration of follow-up.