Robertson C M, Stiller C A, Kingston J E
Department of Paediatrics, University of Oxford.
Arch Dis Child. 1992 Nov;67(11):1378-83. doi: 10.1136/adc.67.11.1378.
An investigation has been undertaken of 479 deaths occurring up to the end of 1990 among 883 patients diagnosed with non-Hodgkin's lymphoma from 1974 to 1985 who were included in the population based National Registry of Childhood Tumours. The objectives were to perform a descriptive analysis looking particularly at the deaths not directly due to non-Hodgkin's lymphoma, to determine the frequency of the different causes of death and to study the trends over time. Among the 476 patients with sufficient information for the cause of death to be established, these were: non-Hodgkin's lymphoma, 377 (79%); treatment related (other than second primary tumour), 86 (18%); second primary tumour, 10 (2%); and other, three (1%). The proportion of all deaths not directly due to non-Hodgkin's lymphoma increased from 15% for those diagnosed during 1974-6 to 32% for those diagnosed during 1983-5. Among the 86 treatment related deaths, the more precise causes were bacterial infections, 26 (30%); viral and other infection, 14 (16%); metabolic, 19 (22%); renal, eight (9%); anaesthetic related, seven (8%); respiratory, four (5%); cardiac, three (3%); graft versus host disease, three (3%); and other, two (2%). Treatment related deaths from infection accounted for 27 (6%) of all patients diagnosed in 1974-9, and 13 (3%) in 1980-5. Treatment related deaths not due to infection occurred in 23 (5%) of those diagnosed in 1974-9 and 23 (6%) in 1980-5. Five treatment related deaths, including four anaesthetic related deaths, were identified as avoidable. Some of the deaths from metabolic and renal disease may also have been avoidable. Only 11 deaths have been recorded more than five years after diagnosis, six being due to second primary tumours. As follow up is relatively short for patients diagnosed more recently, further deaths from second malignancies and treatment related cardiovascular problems may well occur. A substantial number of children with non-Hodgkin's lymphoma die to treatment related causes. Deaths from infection have decreased in line with the overall improvement in survival rates. Other treatment related mortality has remained constant. Further improvements in survival for childhood non-Hodgkin's lymphoma will depend on maintaining the fine balance between the therapeutic value of intensive treatment and its potential harmful effects.
对1974年至1985年被诊断为非霍奇金淋巴瘤的883例患者进行了调查，这些患者被纳入基于人群的国家儿童肿瘤登记处，截至1990年底共发生479例死亡。目的是进行描述性分析，特别关注并非直接由非霍奇金淋巴瘤导致的死亡，确定不同死因的频率，并研究随时间的变化趋势。在476例有足够信息确定死因的患者中，死因如下：非霍奇金淋巴瘤，377例（79%）；与治疗相关（非第二原发性肿瘤），86例（18%）；第二原发性肿瘤，10例（2%）；其他，3例（1%）。并非直接由非霍奇金淋巴瘤导致的所有死亡比例，从1974 - 1976年诊断的患者中的15%，增加到1983 - 1985年诊断的患者中的32%。在86例与治疗相关的死亡中，更确切的死因是：细菌感染，26例（30%）；病毒及其他感染，14例（16%）；代谢性疾病，19例（22%）；肾脏疾病，8例（9%）；与麻醉相关，7例（8%）；呼吸系统疾病，4例（5%）；心脏疾病，3例（3%）；移植物抗宿主病，3例（3%）；其他，2例（2%）。与治疗相关的感染性死亡占1974 - 1979年诊断的所有患者的27例（6%），1980 - 1985年为13例（3%）。非感染性的与治疗相关的死亡在1974 - 1979年诊断的患者中有23例（5%），1980 - 1985年为23例（6%）。确定了5例与治疗相关的死亡为可避免的，包括4例与麻醉相关的死亡。一些代谢性和肾脏疾病导致的死亡也可能是可避免的。诊断后超过五年记录的死亡仅有11例，其中6例是由于第二原发性肿瘤。由于对近期诊断的患者随访时间相对较短，很可能会出现更多由第二原发性恶性肿瘤和与治疗相关的心血管问题导致的死亡。大量非霍奇金淋巴瘤患儿死于与治疗相关的原因。感染导致的死亡随着总体生存率的提高而减少。其他与治疗相关的死亡率保持不变。儿童非霍奇金淋巴瘤生存率的进一步提高将取决于在强化治疗的治疗价值及其潜在有害影响之间保持微妙的平衡。
