Zhao G, Boysen C D, Brown E F, Hassanein K M, Holmes F F, Holmes G E
Henan Institute of Medical Sciences, Henan Medical University, Henan 450052, China.
Chin Med J (Engl). 1999 Jul;112(7):615-9.
To identify factors associated with very long survival among all cancer cases diagnosed at age 19 years or younger registered by the Cancer Data Service at the University of Kansas Medical Center in Kansas City, Kansas, U.S.A. in the 40-year period between 1944 and 1983, with follow-up to 1993.
There were 2720 pediatric patients with 2750 cancers who were studied. Forty-four types of cancer were grouped into 11 diagnostic categories. Diagnosis years spanned four eras: 1944-1953, 1954-1963, 1964-1973, and 1974-1983. Cases were compared using specific characteristics and were divided into short-term and long-term survivors with the division generously set at seven years. The proportions of the long-term survivors were compared by specific characteristics.
Among the diagnostic categories, leukemias were the most common (29.8%), followed by CNS tumors (15.2%), and Hodgkin's disease (9.0%). Male to female ratio was 4:3; average age at diagnosis was 8.83 +/- 6.08 years. Long-term survivors totaled 1148 (41.7%). Prognosis was better in cases diagnosed in earlier stages and in later eras. Proportion of long-term survivors increased from 18.7% in era I to 52.6% in era IV. Improvement of survival was statistically significant in most diagnostic categories.
This study shows continuing improvement of survival during four consecutive eras for childhood and adolescent cancer. Early diagnosis was associated with better survival. Unstaged cases decreased over time reflecting progress in diagnostic techniques. Many patients died before seven years after diagnosis. Those who survived more than seven years had excellent survival. Pediatricians can expect to participate in the care of these patients long after the original dianosis and treatment.
确定1944年至1983年这40年间，在美国堪萨斯州堪萨斯城堪萨斯大学医学中心癌症数据服务处登记的19岁及以下诊断的所有癌症病例中与超长生存期相关的因素，并随访至1993年。
对2720例患有2750种癌症的儿科患者进行了研究。44种癌症类型被分为11个诊断类别。诊断年份跨越四个时期：1944 - 1953年、1954 - 1963年、1964 - 1973年和1974 - 1983年。使用特定特征对病例进行比较，并分为短期和长期幸存者，分界线宽松地设定为7年。通过特定特征比较长期幸存者的比例。
在诊断类别中，白血病最为常见（29.8%），其次是中枢神经系统肿瘤（15.2%）和霍奇金病（9.0%）。男女比例为4:3；诊断时的平均年龄为8.83±6.08岁。长期幸存者共有1148例（41.7%）。早期诊断和较晚时期诊断的病例预后较好。长期幸存者的比例从第一时期的18.7%增加到第四时期的52.6%。大多数诊断类别中生存期的改善具有统计学意义。
本研究表明，儿童和青少年癌症在连续四个时期的生存期持续改善。早期诊断与更好的生存期相关。未分期病例随时间减少，反映了诊断技术的进步。许多患者在诊断后7年内死亡。那些存活超过7年的患者生存期良好。儿科医生可以预期在最初诊断和治疗后很长时间内参与这些患者的护理。
