儿童白血病和淋巴瘤后发生第二原发性恶性肿瘤的风险：一项国际研究。

Risk of second malignant neoplasms after childhood leukemia and lymphoma: an international study.

作者信息

Maule Milena, Scélo Ghislaine, Pastore Guido, Brennan Paul, Hemminki Kari, Tracey Elizabeth, Sankila Risto, Weiderpass Elisabete, Olsen Jorgen H, McBride Mary L, Brewster David H, Pompe-Kirn Vera, Kliewer Erich V, Chia Kee Seng, Tonita Jon M, Martos Carmen, Jonasson Jon G, Merletti Franco, Boffetta Paolo

机构信息

Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, CPO Piemonte, CeRMS, University of Turin, Via Santena 7, 10126, Turin, Italy.

出版信息

J Natl Cancer Inst. 2007 May 16;99(10):790-800. doi: 10.1093/jnci/djk180.

DOI:10.1093/jnci/djk180

PMID:17505074

Abstract

BACKGROUND

Survivors of childhood leukemia and lymphoma experience high risks of second malignant neoplasms. We quantified such risk using a large dataset from 13 population-based cancer registries.

METHODS

The registries provided individual data on cases of leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma occurring in children aged 0-14 years and on subsequent second malignant neoplasms for different time periods from 1943 to 2000. Risks of second malignant neoplasms were assessed through standardized incidence ratios (SIRs) and corresponding 95% confidence intervals (CIs), using the incidence rates in the general populations covered by the registries as a reference. Cumulative absolute risks were also calculated.

RESULTS

A total of 133 second malignant neoplasms were observed in 16,540 patients (12,731 leukemias, 1246 Hodgkin lymphomas, and 2563 non-Hodgkin lymphomas) after an average follow-up of 6.5 years. The most frequent second malignancies after leukemia were brain cancer (19 cases, SIR = 8.52, 95% CI = 5.13 to 13.3), non-Hodgkin lymphoma (nine cases, SIR = 9.41, 95% CI = 4.30 to 17.9), and thyroid cancer (nine cases, SIR = 18.8, 95% CI = 8.60 to 35.7); the most frequent after Hodgkin lymphoma were thyroid cancer (nine cases, SIR = 52.5, 95% CI = 24.0 to 99.6), breast cancer (six cases, SIR = 20.9, 95% CI = 7.66 to 45.4), and neoplasms of skin (non-melanoma) (six cases, SIR = 34.0, 95% CI = 12.5 to 74.0); and the most frequent after non-Hodgkin lymphoma were thyroid cancer (six cases, SIR = 40.4, 95% CI = 14.8 to 88.0) and brain cancer (four cases, SIR = 6.97, 95% CI = 1.90 to 17.9). Cumulative incidence of any second malignant neoplasm was 2.43% (95% CI = 1.09 to 3.78), 12.7% (95% CI = 8.29 to 17.2), and 2.50% (95% CI = 1.04 to 3.96) within 30 years from diagnosis of leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma, respectively.

CONCLUSIONS

This population-based study provides, to our knowledge, the most precise and up-to-date estimates for relative and absolute risks of second malignant neoplasms after childhood leukemia and lymphoma.

摘要

背景

儿童白血病和淋巴瘤幸存者患第二种恶性肿瘤的风险很高。我们使用来自13个基于人群的癌症登记处的大型数据集对这种风险进行了量化。

方法

这些登记处提供了1943年至2000年不同时间段内0至14岁儿童白血病、霍奇金淋巴瘤和非霍奇金淋巴瘤病例以及随后第二种恶性肿瘤的个体数据。通过标准化发病比（SIRs）和相应的95%置信区间（CIs）评估第二种恶性肿瘤的风险，以登记处覆盖的一般人群的发病率作为参考。还计算了累积绝对风险。

结果

在平均随访6.5年后，16540名患者（12731例白血病、1246例霍奇金淋巴瘤和2563例非霍奇金淋巴瘤）中共观察到133例第二种恶性肿瘤。白血病后最常见的第二种恶性肿瘤是脑癌（19例，SIR = 8.52，95% CI = 5.13至13.3）、非霍奇金淋巴瘤（9例，SIR = 9.41，95% CI = 4.30至17.9）和甲状腺癌（9例，SIR = 18.8，95% CI = 8.60至35.7）；霍奇金淋巴瘤后最常见的是甲状腺癌（9例，SIR = 52.5，95% CI = 24.0至99.6）、乳腺癌（6例，SIR = 20.9，95% CI = 7.66至45.4）和皮肤（非黑色素瘤）肿瘤（6例，SIR = 34.0，95% CI = 12.5至74.0）；非霍奇金淋巴瘤后最常见的是甲状腺癌（6例，SIR = 40.4，95% CI = 14.8至88.0）和脑癌（4例，SIR = 6.97，95% CI = 1.90至17.9）。从白血病、霍奇金淋巴瘤和非霍奇金淋巴瘤诊断起30年内，任何第二种恶性肿瘤的累积发病率分别为2.43%（95% CI = 1.09至3.78）、12.7%（95% CI = 8.29至17.2）和2.50%（95% CI = 1.04至3.96）。