Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham, UK.
BJU Int. 2010 Oct;106(7):1060-9. doi: 10.1111/j.1464-410X.2010.09224.x. Epub 2010 Feb 22.
To estimate the risk of a second primary tumour (SPT) of the bladder in a cohort of childhood cancer survivors, investigate factors associated with a bladder SPT developing, and compare the risk observed with that expected from the general population.
The analysis included 17981 individuals diagnosed with childhood cancer, between 1940 and 1991 in Britain, and surviving for ≥5 years. Ascertainment of a bladder SPT was primarily through the National Health Service Central Registers (NHSCR).
From the NHSCR, 17 bladder SPTs were ascertained; this corresponded to four times (95% confidence interval 2.5-6.4) the expected number of bladder tumours. Standardized incidence ratios (SIRs) varied significantly (P < 0.05) by first primary tumour (FPT) type, follow-up period, attained age and chemotherapy. The highest SIRs were in those: with heritable retinoblastoma (31.4); treated with chemotherapy (12.0); 0-9 years of follow-up (10.8); and aged 0-19 years (9.3). The absolute excess risk (AER) for a bladder SPT was 3.7 cases/100000 survivors per year. The AER varied significantly by FPT type, follow-up period, attained age and gender. The highest AERs were in those: diagnosed with heritable retinoblastoma (34.0); 20-29 years of follow-up (14.2); aged 40-49 years (13.0); and male (5.8). Using multivariable Cox regression, FPT and chemotherapy were significantly associated with the risk of a bladder SPT developing. By the age of 55 years, 0.4% of survivors developed a bladder SPT.
Although the absolute risk of a bladder tumour within childhood cancer survivors was low, the risk was four times that expected from the general population. Specific groups, e.g. survivors of heritable retinoblastoma and those treated with chemotherapy, were at the highest risk.
在儿童癌症幸存者队列中估计第二原发肿瘤（SPT）的风险，调查与膀胱癌 SPT 发展相关的因素，并比较观察到的风险与普通人群的预期风险。
该分析包括 1940 年至 1991 年在英国被诊断患有儿童癌症且存活时间≥5 年的 17981 名个体。膀胱癌 SPT 的确定主要通过国家卫生服务中央登记处（NHSCR）进行。
从 NHSCR 中确定了 17 例膀胱癌 SPT，这相当于预期膀胱癌数量的 4 倍（95%置信区间 2.5-6.4）。标准化发病比（SIR）因第一原发肿瘤（FPT）类型、随访时间、获得年龄和化疗而显著不同（P<0.05）。最高的 SIR 见于遗传性视网膜母细胞瘤（31.4）；接受化疗者（12.0）；0-9 年随访者（10.8）；以及 0-19 岁年龄组（9.3）。膀胱癌 SPT 的绝对超额风险（AER）为每年每 100000 名幸存者 3.7 例。AER 因 FPT 类型、随访时间、获得年龄和性别而显著不同。最高的 AER 见于遗传性视网膜母细胞瘤患者（34.0）；20-29 年随访者（14.2）；40-49 岁年龄组（13.0）；以及男性（5.8）。使用多变量 Cox 回归，FPT 和化疗与膀胱癌 SPT 发病风险显著相关。到 55 岁时，0.4%的幸存者发生膀胱癌。
尽管儿童癌症幸存者发生膀胱癌的绝对风险较低，但风险是普通人群预期风险的四倍。特定群体，例如遗传性视网膜母细胞瘤幸存者和接受化疗者，风险最高。
