Erdmann Friederike, Winther Jeanette Falck, Dalton Susanne Oksbjerg, Lightfoot Tracy, Zeeb Hajo, Simony Sofie Bay, Deltour Isabelle, Ferro Gilles, Bautz Andrea, Schmiegelow Kjeld, Schüz Joachim
Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France.
Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark.
Pediatr Blood Cancer. 2016 Jun;63(6):1096-104. doi: 10.1002/pbc.25950. Epub 2016 Mar 3.
Due to diverse findings as to the role of family factors for childhood cancer survival even within Europe, we explored a nationwide, register-based cohort of Danish children with hematological malignancies.
All children born between 1973 and 2006 and diagnosed with a hematological malignancy before the age of 20 years (N = 1,819) were followed until 10 years from diagnosis. Kaplan-Meier curves and Cox proportional hazards models estimating hazard ratios (HR) and 95% confidence intervals (CI) were used to assess the impact of family characteristics on overall survival in children with hematological malignancies.
Having siblings and increasing birth order were associated with reduced survival from acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Associations with AML were strongest and statistically significant. HRs of 1.62 (CI 0.85; 3.09) and 5.76 (CI 2.01; 16.51) were observed for the fourth or later born children with ALL (N = 41) and AML (N = 9), respectively. Children with older parents showed a tendency toward inferior ALL survival, while for AML young maternal age was related to poorer survival. Based on small numbers, a trend toward poorer survival from non-Hodgkin lymphoma was observed for children having siblings and for children of younger parents.
Further research is warranted to gain further knowledge on the impact of family factors on childhood cancer survival in other populations and to elaborate potential underlying mechanisms and pathways of those survival inequalities.
即使在欧洲范围内，关于家庭因素对儿童癌症生存的作用也存在多种研究结果，因此我们对丹麦全国范围内基于登记的血液系统恶性肿瘤儿童队列进行了研究。
对1973年至2006年出生且在20岁之前被诊断为血液系统恶性肿瘤的所有儿童（N = 1819）进行随访，直至确诊后10年。使用Kaplan-Meier曲线和Cox比例风险模型估计风险比（HR）和95%置信区间（CI），以评估家庭特征对血液系统恶性肿瘤儿童总生存的影响。
有兄弟姐妹和出生顺序增加与急性淋巴细胞白血病（ALL）和急性髓系白血病（AML）的生存率降低有关。与AML的关联最强且具有统计学意义。对于ALL（N = 41）和AML（N = 9），分别观察到第四胎及以后出生的儿童的HR为1.62（CI 0.85；3.09）和5.76（CI 2.01；16.51）。父母年龄较大的儿童ALL生存率有降低的趋势，而对于AML，母亲年龄较小与较差的生存率相关。基于少量样本，观察到有兄弟姐妹的儿童和父母年龄较小的儿童非霍奇金淋巴瘤生存率有降低的趋势。
有必要进行进一步研究，以进一步了解家庭因素对其他人群儿童癌症生存的影响，并阐明这些生存不平等的潜在机制和途径。
