Dama Elisa, Pastore Guido, Mosso Maria Luisa, Ferrante Daniela, Maule Milena Maria, Magnani Corrado, Merletti Franco
Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, CPO Piemonte, CeRMS, S.Giovanni Hospital and University of Torino, Torino, Italy.
Haematologica. 2006 Aug;91(8):1084-91. Epub 2006 Jul 25.
The aim of this study was to analyze late mortality among 5-year survivors of childhood cancer, in Piedmont (Italy), in terms of risk factors and causes of death.
From 1967 to 1999, the Childhood Cancer Registry of Piedmont recorded 3164 incident cases. Patients identified only by a death certificate (n = 59), lost to follow-up (n = 32), alive with a period of observation shorter than 5 years at the end of follow-up (n = 65) and records corresponding to a second malignant tumor during childhood (n = 9) were excluded from the analyses.
Within 5 years after diagnosis, 1301 children died, and among the 1698 5- year survivors, 144 children subsequently died. Among 5-year survivors, cumulative mortality percentages increased from 5.1% (95% CI 4.0-6.2) at 10 years after diagnosis to 16.0% (12.2-19.8) at 35 years. Period of diagnosis (p = 0.006), age at diagnosis (p = 0.002), and tumor type (p = 0.003) were associated with late mortality. Most deaths were related to cancer recurrence (62.2%) and treatment-related sequelae (22.4%), including second malignant neoplasms, cardiac diseases and other late effects. Compared to the general population, children included in this study had a 9-fold increased risk of overall mortality, and experienced an absolute excess of 4.4 deaths per 1000 person-years.
Among 5-year survivors, patients treated more recently (after 1979) had a statistically significant lower risk of late death than those treated earlier. However, long-term survivors still experienced higher mortality rates than those in the general population, and recurrence or progression of the primary tumor was the first cause of death.
本研究旨在分析意大利皮埃蒙特地区儿童癌症5年幸存者的晚期死亡率，包括危险因素和死亡原因。
1967年至1999年，皮埃蒙特儿童癌症登记处记录了3164例新发病例。分析中排除了仅通过死亡证明识别的患者（n = 59）、失访患者（n = 32）、随访结束时观察期短于5年仍存活的患者（n = 65）以及儿童期对应第二原发恶性肿瘤的记录（n = 9）。
诊断后5年内，1301名儿童死亡，在1698名5年幸存者中，有144名儿童随后死亡。在5年幸存者中，累积死亡率从诊断后10年的5.1%（95%可信区间4.0 - 6.2）增加到35年时的16.0%（12.2 - 19.8）。诊断时期（p = 0.006）、诊断年龄（p = 0.002）和肿瘤类型（p = 0.003）与晚期死亡率相关。大多数死亡与癌症复发（62.2%）和治疗相关后遗症（22.4%）有关，包括第二原发恶性肿瘤、心脏病和其他晚期效应。与一般人群相比，本研究中的儿童总体死亡风险增加了9倍，每1000人年绝对额外死亡4.4例。
在5年幸存者中，近期（1979年后）接受治疗的患者晚期死亡风险在统计学上显著低于早期接受治疗的患者。然而，长期幸存者的死亡率仍高于一般人群，原发肿瘤的复发或进展是首要死亡原因。
