北爱尔兰癌症幸存儿童及青少年的死亡率

Mortality Among Children And Young People Who Survive Cancer In Northern Ireland.

作者信息

Donnelly D W, Gavin A T

机构信息

N. Ireland Cancer Registry, Queen's University Belfast.

出版信息

Ulster Med J. 2016 Sep;85(3):158-163.

PMID:27698517

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5031102/

Abstract

ABSTRACT

Whilst survival rates for childhood cancers are excellent, it is known that these patients have an increased risk of death from disease recurrence and other causes. We investigate patterns, trends and survival of cancers in children and young adults in N. Ireland.

MATERIALS AND METHODS

21 years (1993-2013) of cancer incidence data including non-malignant brain tumours from the N. Ireland Cancer Registry for persons aged 0-24 years was analysed using Joinpoint regresssion for trend and the Kaplan Meier method for survival analysis up to end 2013 with excess mortality calculated at one and five years after first cancer diagnosis using standardised mortality ratios.

RESULTS

2633 children and young people were diagnosed with cancer, 1386 (52.6%) male and 1247 female with 1139 (43.3%) aged 0-14. While trends increased over time they did not reach statistical significance except in the 15-24 age group for males and females combined. The most common cancers for age 0-14 were brain, eye and central nervous system and leukaemia with skin (including non-melanoma skin) the most common in the 15-24 age group. 59 patients (2.2%) had a record of a second cancer. Survival was high at 90.7% after 1 year, better among females and similar for older and younger groups. Although mortality in children is low overall, there was an excess mortality 24.7% (22-27.5) p<0.001 at one year and 7.3% (5.5-9.2) p<0.001 for those who survived 5 years. Excluding the primary cancer there was an excess mortality for one year survivors, with deaths twice that of the background level (SMR= 2.2 (1.3-3.0)p=0.005 and although one and a half times background levels at 5 years, the excess mortality was not significant 1.5 (0.6-2.3 p=0.269).

CONCLUSION

Whilst survival from childhood cancers is excellent, this work in common with larger studies, highlights the need for ongoing monitoring of cancer survivors. Preventable skin cancer was identified as a problem in young adults.

摘要

虽然儿童癌症的生存率很高，但众所周知，这些患者因疾病复发和其他原因导致死亡的风险增加。我们调查了北爱尔兰儿童和青年癌症的发病模式、趋势及生存率。

材料与方法

分析北爱尔兰癌症登记处1993年至2013年21年间0至24岁人群的癌症发病数据，包括非恶性脑肿瘤，使用Joinpoint回归分析趋势，采用Kaplan-Meier方法进行生存分析，直至2013年底，使用标准化死亡率计算首次癌症诊断后1年和5年的超额死亡率。

结果

2633名儿童和青年被诊断患有癌症，其中1386名（52.6%）为男性，1247名女性，1139名（43.3%）年龄在0至14岁。虽然发病率随时间呈上升趋势，但除15至24岁男女合并年龄组外，均未达到统计学显著性。0至14岁最常见的癌症是脑、眼和中枢神经系统癌症以及白血病，15至24岁年龄组最常见的是皮肤癌（包括非黑色素瘤皮肤癌）。59名患者（2.2%）有第二次癌症记录。1年后生存率高达90.7%，女性生存率更高，年龄较大和较小的组相似。虽然儿童总体死亡率较低，但1年时超额死亡率为24.7%（22-27.5），p<0.001，5年存活者的超额死亡率为7.3%（5.5-9.2），p<0.001。排除原发性癌症后，1年存活者存在超额死亡率，死亡人数是背景水平的两倍（标准化死亡比=2.2（1.3-3.），p=0.005），虽然5年时是背景水平的1.5倍，但超额死亡率不显著，为1.5（0.6-2.3），p=0.269。