Swerdlow A J, Reddingius R E, Higgins C D, Spoudeas H A, Phipps K, Qiao Z, Ryder W D, Brada M, Hayward R D, Brook C G, Hindmarsh P C, Shalet S M
Section of Epidemiology, Institute of Cancer Research, Sutton, Surrey SM2 5NG.
J Clin Endocrinol Metab. 2000 Dec;85(12):4444-9. doi: 10.1210/jcem.85.12.7044.
GH is increasingly used for treatment of children and adults. It is mitogenic, however, and there is therefore concern about its safety, especially when used to treat cancer patients who have become GH deficient after cranial radiotherapy. We followed 180 children with brain tumors attending three large hospitals in the United Kingdom and treated with GH during 1965-1996, and 891 children with brain tumors at these hospitals who received radiotherapy but not GH. Thirty-five first recurrences occurred in the GH-treated children and 434 in the untreated children. The relative risk of first recurrence in GH-treated compared with untreated patients, adjusted for potentially confounding prognostic variables, was decreased (0. 6; 95% confidence interval, 0.4-0.9) as was the relative risk of mortality (0.5; 95% confidence interval, 0.3-0.8). There was no significant trend in relative risk of recurrence with cumulative time for which GH treatment had been given or with time elapsed since this treatment started. The relative risk of mortality increased significantly with time since first GH treatment. The results, based on much larger numbers than previous studies, suggest that GH does not increase the risk of recurrence of childhood brain tumors, although the rising trend in mortality relative risks with longer follow-up indicates the need for continued surveillance.
生长激素（GH）越来越多地用于儿童和成人的治疗。然而，它具有促有丝分裂作用，因此人们对其安全性表示担忧，尤其是在用于治疗因颅脑放疗后出现GH缺乏的癌症患者时。我们随访了1965年至1996年期间在英国三家大型医院接受GH治疗的180名患有脑肿瘤的儿童，以及这些医院中891名接受了放疗但未使用GH的患有脑肿瘤的儿童。接受GH治疗的儿童中有35例首次复发，未接受治疗的儿童中有434例首次复发。在对潜在的混杂预后变量进行调整后，接受GH治疗的患者与未接受治疗的患者相比，首次复发的相对风险降低（0.6；95%置信区间，0.4 - 0.9），死亡的相对风险也降低（0.5；95%置信区间，0.3 - 0.8）。复发的相对风险与给予GH治疗的累积时间或自开始治疗以来经过的时间没有显著趋势。自首次GH治疗以来，死亡的相对风险随时间显著增加。基于比以往研究大得多的样本量得出的结果表明，GH不会增加儿童脑肿瘤复发的风险，尽管随着随访时间延长，死亡相对风险呈上升趋势表明仍需要持续监测。
