Bluhm Elizabeth C, Ronckers Cécile, Hayashi Robert J, Neglia Joseph P, Mertens Ann C, Stovall Marilyn, Meadows Anna T, Mitby Pauline A, Whitton John A, Hammond Sue, Barker Joseph D, Donaldson Sarah S, Robison Leslie L, Inskip Peter D
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, MSC 7238, Rockville, MD 20892-7238, USA.
Blood. 2008 Apr 15;111(8):4014-21. doi: 10.1182/blood-2007-08-106021. Epub 2008 Feb 7.
Second primary malignancies and premature death are a concern for patients surviving treatment for childhood lymphomas. We assessed mortality and second malignant neoplasms (SMNs) among 1082 5-year survivors of non-Hodgkin lymphoma (NHL) in the Childhood Cancer Survivor Study, a multi-institutional North American retrospective cohort study of cancer survivors diagnosed from 1970 to 1986. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were calculated using US population rates. Relative risks for death and solid tumor SMNs were calculated based on demographic, clinical, and treatment characteristics using Poisson regression models. There were 87 observed deaths (SMR = 4.2; 95% CI, 1.8-4.1) with elevated rates of death from solid tumors, leukemia, cardiac disease, and pneumonia. Risk for death remained elevated beyond 20 years after NHL. Risk factors for death from causes other than NHL included female sex (rate ratio [RR] = 3.4) and cardiac radiation therapy exposure (RR = 1.9). There were 27 solid tumor SMNs (SIR = 3.9; 95% CI, 2.6-5.7) with 3% cumulative incidence between 5 and 20 years after NHL diagnosis. Risk factors were female sex (RR = 3.1), mediastinal NHL disease (RR = 5.2), and breast irradiation (RR = 4.3). Survivors of childhood NHL, particularly those treated with chest RT, are at continued increased risk of early mortality and solid tumor SMNs.
对于儿童淋巴瘤治疗后存活的患者而言，第二原发性恶性肿瘤和过早死亡是令人担忧的问题。在儿童癌症幸存者研究中，我们评估了1082名非霍奇金淋巴瘤（NHL）5年幸存者的死亡率和第二原发性恶性肿瘤（SMN）情况。该研究是一项北美多机构的回顾性队列研究，研究对象为1970年至1986年期间确诊的癌症幸存者。使用美国人群发病率计算标准化死亡率（SMR）和标准化发病率（SIR）。基于人口统计学、临床和治疗特征，使用泊松回归模型计算死亡和实体瘤SMN的相对风险。观察到87例死亡（SMR = 4.2；95% CI，1.8 - 4.1），实体瘤、白血病、心脏病和肺炎导致的死亡率升高。NHL诊断后20年以上死亡风险仍然升高。NHL以外原因导致死亡的风险因素包括女性（率比[RR] = 3.4）和心脏放射治疗暴露（RR = 1.9）。有27例实体瘤SMN（SIR = 3.9；95% CI，2.6 - 5.7），NHL诊断后5至20年累积发病率为3%。风险因素为女性（RR = 3.1）、纵隔NHL疾病（RR = 5.2）和胸部放疗（RR = 4.3）。儿童NHL幸存者，尤其是接受胸部放疗的幸存者，早期死亡和实体瘤SMN的持续风险增加。
