Melanoma as a subsequent neoplasm in adult survivors of childhood cancer: a report from the childhood cancer survivor study.

Melanoma as a subsequent neoplasm in adult survivors of childhood cancer: a report from the childhood cancer survivor study.
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DOI:
10.1002/pbc.24266
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发表时间:
2013-03
影响因子:
3.2
通讯作者:
Robison, L. L.
Robison, L. L.
中科院分区:
医学3区
文献类型:
--
作者:
Pappo, A. S.;Armstrong, G. T.;Liu, W.;Srivastava, D. K.;McDonald, A.;Leisenring, W. M.;Hammond, S.;Stovall, M.;Neglia, J. P.;Robison, L. L.

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与一般人群相比,儿童癌症幸存者发生后续肿瘤的风险增加了6倍。我们试图描述黑色素瘤作为儿童癌症成年幸存者的后续肿瘤的发生。在1970-86年间诊断的14,358例5年生存儿童癌症患者中,我们计算了随后黑色素瘤的累积发病率、标准化发病率比(SIR)和绝对超额风险(AER)。使用特定原因危害模型评估潜在风险因素。51例存活者中发生57例恶性黑色素瘤,其中侵袭性46例,眼部2例,原位9例。至发生黑色素瘤的中位时间为21.0年(范围5.6-35.4年),发生黑色素瘤的中位年龄为32.3岁(范围10.9 - 49.0岁)。最初的癌症诊断包括软组织和骨肉瘤(n=15)、白血病(13)、淋巴瘤(14)、中枢神经系统恶性肿瘤(5)、肾母细胞瘤(3)和神经母细胞瘤(1)。自首次癌症诊断后35年首次后续黑色素瘤的累积发生率为0.55%(95% CI 0.37-0.73)。后续皮肤浸润性恶性黑色素瘤的SIR为2.42(95% CI 1.77 - 3.23),AER为0.10(95% CI 0.05 - 0.15)/1,000人年。黑色素瘤风险与癌症家族史、人口统计学或治疗相关因素之间没有统计学显著相关性。儿童癌症的幸存者患黑色素瘤的风险增加约2.5倍。早期筛查和预防策略是必要的。
Childhood cancer survivors have a six fold increased risk of developing subsequent neoplasms when compared to the general population. We sought to describe the occurrence of melanoma as a subsequent neoplasm among adult survivors of childhood cancer. Among 14,358 5-year survivors of childhood cancer diagnosed between 1970–86, we calculated the cumulative incidence, standardized incidence ratio (SIR), and absolute excess risk (AER) of subsequent melanoma. Potential risk factors were assessed using a cause-specific hazards model. 57 melanomas (46 invasive, 2 ocular and 9 in situ) occurred in 51 survivors. The median time to the development of melanoma was 21.0 years (range 5.6–35.4 years) and the median age at melanoma was 32.3 years (range 10.9 – 49.0 years). Initial cancer diagnoses included soft tissue and bone sarcoma (n=15), leukemia (13), lymphoma (14), central nervous system malignancy (5), Wilms’ tumor (3), and neuroblastoma (1). The cumulative incidence of first subsequent melanoma at 35 years from initial cancer diagnosis was 0.55% (95% CI 0.37–0.73). The SIR of subsequent invasive malignant melanoma of the skin was 2.42 (95% CI 1.77 – 3.23), and the AER was 0.10 (95% CI 0.05 – 0.15) per 1,000 person years. No statistically significant associations were found between melanoma risk and family history of cancer, demographic, or treatment-related factors. Survivors of childhood cancer have an approximate 2.5-fold increased risk of melanoma. Early screening and prevention strategies are warranted.
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