Geenen Maud M, Cardous-Ubbink Mathilde C, Kremer Leontien C M, van den Bos Cor, van der Pal Helena J H, Heinen Richard C, Jaspers Monique W M, Koning Caro C E, Oldenburger Foppe, Langeveld Nelia E, Hart Augustinus A M, Bakker Piet J M, Caron Huib N, van Leeuwen Flora E
Late Effects Study Group and Outpatient Clinic/Polikliniek Late Effecten Kindertumoren (PLEK), Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
JAMA. 2007 Jun 27;297(24):2705-15. doi: 10.1001/jama.297.24.2705.
Improved survival of children with cancer has been accompanied by multiple treatment-related complications. However, most studies in survivors of childhood cancer focused on only 1 late effect.
To assess the total burden of adverse health outcomes (clinical or subclinical disorders ["adverse events"]) following childhood cancer in a large cohort of childhood cancer survivors with long-term and complete medical follow-up.
DESIGN, SETTING, AND POPULATION: Retrospective cohort study of 1362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996. All survivors were invited to a late-effects clinic for medical assessment of adverse events. Adverse events occurring before January 2004 were graded for severity in a standardized manner.
Treatment-specific prevalence of adverse events (according to severity) at end of follow-up and relative risk of high or severe burden of disease (> or =2 severe or > or =1 life-threatening or disabling adverse events) associated with various treatments.
Medical follow-up was complete for 94.3% of survivors (median follow-up, 17.0 years). The median attained age at end of follow-up was 24.4 years. Almost 75% of survivors had 1 or more adverse events, and 24.6% had 5 or more adverse events. Furthermore, 40% of survivors had at least 1 severe or life-threatening or disabling adverse event. A high or severe burden of adverse events was observed in 55% of survivors who received radiotherapy only and 15% of survivors treated with chemotherapy only, compared with 25% of survivors who had surgery only (adjusted relative risks, 2.18 [95% confidence interval, 1.62-2.95] and 0.65 [95% confidence interval, 0.46-0.90], respectively). A high or severe burden of adverse events was most often observed in survivors of bone tumors (64%) and least often in survivors of leukemia or Wilms tumor (12% each).
In young adulthood, a substantial proportion of childhood cancer survivors already has a high or severe burden of disease, particularly after radiotherapy. This underscores the need for lifelong risk-stratified medical surveillance of childhood cancer survivors.
儿童癌症患者生存率的提高伴随着多种与治疗相关的并发症。然而，大多数关于儿童癌症幸存者的研究仅关注一种晚期效应。
在一大群接受长期且完整医学随访的儿童癌症幸存者中，评估儿童癌症后不良健康结局（临床或亚临床疾病 ["不良事件"]）的总体负担。
设计、地点和人群：对1966年至1996年期间在荷兰一家机构接受治疗的1362名儿童癌症五年幸存者进行回顾性队列研究。所有幸存者均被邀请到晚期效应诊所进行不良事件的医学评估。2004年1月之前发生的不良事件按照标准化方式进行严重程度分级。
随访结束时特定治疗的不良事件患病率（根据严重程度）以及与各种治疗相关的高或严重疾病负担（≥2种严重或≥1种危及生命或致残的不良事件）的相对风险。
94.3%的幸存者完成了医学随访（中位随访时间为17.0年）。随访结束时的中位达到年龄为24.4岁。近75%的幸存者有1种或更多不良事件，24.6%的幸存者有5种或更多不良事件。此外，40%的幸存者至少有1种严重或危及生命或致残的不良事件。仅接受放疗的幸存者中有55%观察到高或严重的不良事件负担，仅接受化疗的幸存者中有15%观察到这种情况，而仅接受手术的幸存者中有25%观察到这种情况（调整后的相对风险分别为2.18 [95%置信区间，1.62 - 2.95]和0.65 [95%置信区间，0.46 - 0.90]）。骨肿瘤幸存者中最常观察到高或严重的不良事件负担（64%），白血病或肾母细胞瘤幸存者中最不常观察到（均为12%）。
在成年早期，相当一部分儿童癌症幸存者已经有高或严重的疾病负担，尤其是放疗后。这凸显了对儿童癌症幸存者进行终身风险分层医学监测的必要性。
