睾丸癌幸存者患白血病的风险：一项基于人群的对42722名患者的研究。
Risk of leukemia among survivors of testicular cancer: a population-based study of 42,722 patients.
作者信息
Howard Regan, Gilbert Ethel, Lynch Charles F, Hall Per, Storm Hans, Holowaty Eric, Pukkala Eero, Langmark Froydis, Kaijser Magnus, Andersson Michael, Joensuu Heikki, Fossa Sophie D, Allan James M, Travis Lois B
机构信息
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
出版信息
Ann Epidemiol. 2008 May;18(5):416-21. doi: 10.1016/j.annepidem.2008.01.003.
PURPOSE
The aim of this study is to quantify excess absolute risk (EAR) and excess relative risk (ERR) of secondary leukemia among a large population-based group of testicular cancer survivors.
METHODS
We identified 42,722 1-year survivors of testicular cancer within 14 population-based cancer registries in Europe and North America (1943-2002). Poisson regression analysis was used to model EAR (per 100,000 person-years [PY]) and ERR of secondary leukemia. Cumulative risks were calculated using a competing risk model.
RESULTS
Secondary leukemia developed in 89 patients (EAR = 10.8 per 100,000 PY, 95% confidence interval [CI] = 7.6-14.6; ERR = 1.6, 95%CI = 1.0-2.2). Statistically significantly elevated risks were observed for acute myeloid leukemia (AML) (EAR = 7.2, 95%CI = 4.7-10.2) and acute lymphoblastic leukemia (EAR = 1.3, 95%CI = 0.4-2.8). In multivariate analyses, AML risk was higher among patients whose initial management included chemotherapy compared to those receiving radiotherapy alone (p = 0.1). Excess cumulative leukemia risk was approximately 0.23% by 30 years after testicular cancer diagnosis.
CONCLUSIONS
Although ERR of leukemia following testicular cancer is large, EAR and cumulative risk, which are better gauges of the population burden, are small.
目的
本研究旨在量化一大群基于人群的睾丸癌幸存者中继发性白血病的超额绝对风险（EAR）和超额相对风险（ERR）。
方法
我们在欧洲和北美的14个基于人群的癌症登记处中识别出42,722名睾丸癌1年幸存者（1943 - 2002年）。采用泊松回归分析对继发性白血病的EAR（每100,000人年[PY]）和ERR进行建模。使用竞争风险模型计算累积风险。
结果
89名患者发生了继发性白血病（EAR = 每100,000 PY为10.8，95%置信区间[CI] = 7.6 - 14.6；ERR = 1.6，95%CI = 1.0 - 2.2）。观察到急性髓系白血病（AML）（EAR = 7.2，95%CI = 4.7 - 10.2）和急性淋巴细胞白血病（EAR = 1.3，95%CI = 0.4 - 2.8）的风险在统计学上显著升高。在多变量分析中，初始治疗包括化疗的患者与仅接受放疗的患者相比，AML风险更高（p = 0.1）。睾丸癌诊断后30年，超额累积白血病风险约为0.23%。
结论
虽然睾丸癌后白血病的ERR很大，但EAR和累积风险（它们是衡量人群负担的更好指标）很小。
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