Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence
Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence
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DOI：
10.1200/jco.2000.18.7.1492
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发表时间：
2000-04-01
影响因子：
45.3
通讯作者：
Zevon, MA
中科院分区：
文献类型：
--
作者：
Green, DM;Hyland, A;Zevon, MA
目的：确定儿童和青少年诊断的霍奇金病治疗后第二恶性肿瘤 (SMN) 的发生频率和危险因素。 患者和方法：1960 年 1 月 1 日至 12 月 31 日期间，连续 182 名既往未接受治疗的霍奇金病患者诊断时年龄小于 20 岁，并转诊至罗斯威尔帕克癌症研究所（纽约州布法罗）接受治疗。 1989年进行了研究，计算了特定性别的标准化发病率（SIR）。进行 Kaplan-Meier 生存估计和 Cox 回归分析以确定几个人口统计和治疗变量与 SMN 发生率的关系。 结果：28 名患者在诊断霍奇金病后平均 14.93 +/- 8.09 年（范围为 2.65 至 29.88 年）出现 SMN。诊断后 30 年出现 SMN 的患者累积百分比为 26.27 +/- 6.75%，男性患者的 SIR 为 9.39（95% 置信区间 [Cl]，4.05 至 18.49），女性患者为 10.16（95% CI，5.56 至 17.05）。最常见的 SMN 是甲状腺癌、乳腺癌、非黑色素瘤皮肤癌癌症、非霍奇金淋巴瘤和急性白血病。对性别、任何烷化剂治疗、多柔比星治疗、脾切除术以及复发（作为时间依赖性协变量）与 SMN 发病时间的多变量分析均得出不显着的结果。结论：成功治疗的霍奇金病儿童和青少年存在随后发生肿瘤的重大风险，最常见的 SMN（甲状腺和乳腺）很容易通过体检和可用的筛查程序检测到。 (C) 2000 年美国临床肿瘤学会。
Purpose: To determine the frequency of and risk factors for second malignant neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in children and adolescents.Patients and Methods: One hundred eighty-two consecutive, previously untreated patients with Hodgkin's disease who were younger than 20 years of age at diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo, NY) for treatment between January 1, 1960, and December 31, 1989, were studied, Sex-specific standardized incidence ratios (SIRs) were calculated. Kaplan-Meier survival estimates and Cox regression analyses were performed to determine the relationship of several demographic and treatment variables to SMN incidence.Results: Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. The cumulative percentage of patients who developed an SMN was 26.27 +/- 6.75% at 30 years after diagnosis, The SIR was 9.39 (95% confidence interval [Cl], 4.05 to 18.49) for male patients and 10.16 (95% Cl, 5.56 to 17.05) for female patients, The most frequent SMNs were thyroid cancer, breast cancer, nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Multivariate analysis of sex, treatment with any alkylating agent, treatment with doxorubicin, splenectomy, and relapse (as a time-dependent covariate) with time to SMN onset gave nonsignificant results.Conclusion: Successfully treated children and adolescents with Hodgkin's disease have a substantial risk for the occurrence of subsequent neoplasms, The most frequent SMNs (skint thyroid, and breast) ore readily detected by physical examination and available screening procedures. (C) 2000 by American Society of Clinical Oncology.