Taylor Aliki J, Croft Adam P, Palace Aimee M, Winter David L, Reulen Raoul C, Stiller Charles A, Stevens Michael C G, Hawkins Mike M
Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Int J Cancer. 2009 Nov 15;125(10):2400-5. doi: 10.1002/ijc.24581.
Second primary neoplasms (SPNs) are a recognised late effect of treatment for childhood cancer. Thyroid SPNs can develop after exposure to low-dose radiation, due to the radio-sensitivity of the thyroid gland. The British Childhood Cancer Survivor Study (BCCSS) was set up to directly monitor the late effects of treatment, including risk of SPNs, in childhood cancer survivors and includes 17,980 5-year survivors. We carried out a cohort analysis to determine the risk of thyroid SPNs in the BCCSS, and estimated risk using standardised incidence ratios (SIRs), relative risk (RR) using multivariate Poisson regression and cumulative incidence curves. There were 340,202 person years at risk subsequent to a 5-year survival, median follow-up 17.4 years per survivor. We identified 50 thyroid SPNs including 31 (62%) papillary carcinomas, 15 (30%) follicular carcinomas and 4 (8%) other types. 88% of thyroid SPNs developed after exposure to radiotherapy in or around the thyroid gland. SIR overall was 18.0 (95% confidence interval 13.4-23.8). Risk of thyroid cancer was highest after Hodgkin's disease: RR 3.3 (1.1-10.1) and Non Hodgkin's Lymphoma: RR 3.4 (1.1-10.7) relative to leukaemia (RR 1.0) (p < 0.001). Survivors treated with radiotherapy in childhood had a RR of 4.6 (1.4-15.1) relative to survivors not treated with radiotherapy (RR 1.0), p = 0003. In conclusion, the risk of thyroid cancer in childhood cancer survivors is relatively high in this cohort of childhood cancer survivors. These results will be of use in counselling survivors of childhood cancer exposed to radiation in or around the thyroid area.
第二原发性肿瘤（SPNs）是儿童癌症治疗公认的晚期效应。由于甲状腺的放射敏感性，甲状腺SPNs可在低剂量辐射暴露后发生。英国儿童癌症幸存者研究（BCCSS）旨在直接监测儿童癌症幸存者治疗的晚期效应，包括SPNs风险，该研究纳入了17980名5年幸存者。我们进行了一项队列分析，以确定BCCSS中甲状腺SPNs的风险，并使用标准化发病比（SIRs）、多变量泊松回归的相对风险（RR）和累积发病率曲线估计风险。5年生存后有340202人年处于风险中，每位幸存者的中位随访时间为17.4年。我们识别出50例甲状腺SPNs，包括31例（62%）乳头状癌、15例（30%）滤泡状癌和4例（8%）其他类型。88%的甲状腺SPNs在甲状腺内或其周围接受放射治疗后发生。总体SIR为18.0（95%置信区间13.4 - 23.8）。相对于白血病（RR = 1.0），霍奇金病后甲状腺癌风险最高：RR为3.3（1.1 - 10.1），非霍奇金淋巴瘤：RR为3.4（1.1 - 10.7）（p < 0.001）。儿童期接受放射治疗的幸存者相对于未接受放射治疗的幸存者（RR = 1.0），RR为4.6（1.4 - 15.1），p = 0.003。总之，在这一队列儿童癌症幸存者中，儿童癌症幸存者患甲状腺癌的风险相对较高。这些结果将有助于为甲状腺区域内或周围接受过辐射的儿童癌症幸存者提供咨询。
