Trombert-Paviot B, Frappaz D, Casagranda L, Plantaz D, Bertrand Y, Stephan J-L, Berger C, Freycon F
CIM 42, service de santé publique et d'information médicale, hôpital Nord, CHU de St-Etienne, 42055 St-Etienne cedex, France.
Rev Epidemiol Sante Publique. 2008 Dec;56(6):383-90. doi: 10.1016/j.respe.2008.08.003. Epub 2008 Nov 13.
The population of survivors of childhood cancer is currently growing. Studies from other countries have shown an increased risk of late mortality. In order to measure this risk within a French cohort, the mortality of children who had survived five years from a cancer diagnosis were compared to the mortality of the general population, according to follow-up interval and cancer and treatment characteristics.
The study population consisted of 635 children diagnosed with cancer before the age of 15 who had survived at least five years, and were registered in the Rhone-Alpes region cancer registry from 1987 to 1992. Mortality was compared with general population rates of the Rhone-Alpes region to assess age and sex standardized mortality ratio (SMR) and absolute excess risk of death.
The median follow-up of children was 14.0 years. Among the 42 observed deaths, 71.4% were attributed to a recurrence of the original cancer, 9.5% to a second cancer. The 15-year cumulative risk of death, all causes, was 7.1%. The overall mortality of the cohort was 20.7 fold greater than the general population (95% CI: 14.9-27.9), and the absolute excess risk of 6.9 per 1000 persons-years. The long term excess-mortality was higher in case of recurrence of original cancer (SMR=99.9, 95% CI: 67.9-141.9, absolute excess risk 35.4 per 1000 persons-years); it was raised during the five to nine years follow-up interval after diagnosis (SMR=33.8, 95% CI: 23.2-47.3) mainly due to the primary malignancy, and decreased after (10-14 years follow-up interval SMR=6.5, 95% IC 2.4-14.2).
The late mortality of childhood cancer is significantly increased during the five to nine years following diagnosis and decreases after, but the cohort follow-up has to be extended in order to assess outcome beyond 15 years after diagnosis.
目前，儿童癌症幸存者的数量正在增加。其他国家的研究表明，晚期死亡风险有所上升。为了在法国队列中衡量这种风险，根据随访间隔、癌症及治疗特征，将癌症诊断后存活五年的儿童死亡率与一般人群的死亡率进行了比较。
研究人群包括635名15岁前被诊断患有癌症且至少存活五年的儿童，他们于1987年至1992年在罗纳-阿尔卑斯地区癌症登记处登记。将死亡率与罗纳-阿尔卑斯地区的一般人群率进行比较，以评估年龄和性别标准化死亡率比（SMR）及绝对超额死亡风险。
儿童的中位随访时间为14.0年。在42例观察到的死亡病例中，71.4%归因于原发性癌症复发，9.5%归因于第二种癌症。所有原因导致的15年累积死亡风险为7.1%。该队列的总体死亡率比一般人群高20.7倍（95%可信区间：14.9 - 27.9），绝对超额风险为每1000人年6.9例。原发性癌症复发时长期超额死亡率更高（SMR = 99.9，95%可信区间：67.9 - 141.9，绝对超额风险为每1000人年35.4例）；在诊断后的五至九年随访间隔期间升高（SMR = 33.8，95%可信区间：23.2 - 47.3），主要归因于原发性恶性肿瘤，之后降低（10 - 14年随访间隔SMR = 6.5，95%可信区间2.4 - 14.2）。
儿童癌症的晚期死亡率在诊断后的五至九年显著增加，之后降低，但队列随访必须延长，以便评估诊断后15年以上的结局。
