Rudolfstiftung Hospital, 1st Medical Department, Vienna, Austria.
Pfizer Endocrine Care, Sollentuna, Sweden.
J Clin Endocrinol Metab. 2018 Feb 1;103(2):523-531. doi: 10.1210/jc.2017-01899.
Data on the association between growth hormone (GH) replacement in patients with GH deficiency (GHD) after malignancies and new neoplasms show conflicting results.
To clarify the incidence of new malignant neoplasm in childhood-onset (CO) and adult-onset (AO) adult cancer survivors (CSs).
Retrospective comparison of CO-CS and AO-CS with CO idiopathic GHD (IGHD) and AO nonfunctioning pituitary adenoma (NFPA) patients and with the general population [standardized incidence ratio (SIR)].
Data from the Pfizer International Metabolic Database study (KIMS).
CO-CS [n = 349; 50.4% females; mean baseline (MBL) IGF-I standard deviation score (SDS), -2.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, -3.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, -1.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, -1.0).
SIRs of malignant neoplasms.
After a median follow-up of 5.9 years (2192 patient-years), 15 CO-CS (4.3%) had developed 16 new neoplasms. The SIR was 10.4 [95% confidence interval (CI), 5.9 to 16.9] and 6.5 (95% CI, 3.0 to 12.4) after exclusion of seven patients with skin cancers. In IGHD, three malignant neoplasms (0.5%) were observed after a median follow-up of 5.4 years (3908 patient-years; SIR, 0.47; 95% CI, 0.09 to 1.37). New malignant neoplasms occurred in three AO-CS (1.7%; SIR, 1.1; 95% CI, 0.2 to 3.2) and 146 NFPA patients (153 cases, 6.0%; SIR, 1.1; 95% CI, 0.9 to 1.2) after a median follow-up of 4.9 (1024 patient-years) and 5.6 years (15,215 patient-years).
The risk of second malignant neoplasms was increased in CO-CS but not in AO-CS, which illustrates the need to closely follow patients on GH replacement because of a prior malignancy.
关于生长激素（GH）替代治疗恶性肿瘤后 GH 缺乏症（GHD）患者和新发肿瘤之间关系的数据结果相互矛盾。
明确儿童期（CO）和成年期（AO）成人癌症幸存者（CSs）中新发恶性肿瘤的发病率。
CO-CS 和 AO-CS 与 CO 特发性 GHD（IGHD）和 AO 无功能垂体腺瘤（NFPA）患者以及与普通人群的回顾性比较[标准化发病比（SIR）]。
辉瑞国际代谢数据库研究（KIMS）的数据。
CO-CS[349 例；50.4%为女性；平均基线（MBL）IGF-I 标准差评分（SDS），-2.4]，IGHD（619 例；35.7%为女性；MBL IGF-I SDS，-3.4），AO-CS（174 例；42.5%为女性；MBL IGF-I SDS，-1.4）和 NFPA（2449 例；38.1%为女性；MBL IGF-I SDS，-1.0）。
恶性肿瘤的 SIRs。
中位随访 5.9 年后（2192 患者年），15 例 CO-CS（4.3%）发生 16 例新发肿瘤。SIR 为 10.4[95%置信区间（CI），5.9 至 16.9]，排除 7 例皮肤癌患者后为 6.5（95%CI，3.0 至 12.4）。在 IGHD 中，中位随访 5.4 年后（3908 患者年）观察到 3 例恶性肿瘤（0.5%）；SIR 为 0.47（95%CI，0.09 至 1.37）。中位随访 4.9 年（1024 患者年）和 5.6 年（15215 患者年）后，3 例 AO-CS（1.7%）和 146 例 NFPA 患者（153 例）发生新的恶性肿瘤（SIR 分别为 1.1、95%CI，0.2 至 3.2 和 1.1、95%CI，0.9 至 1.2）。
CO-CS 患者新发第二恶性肿瘤的风险增加，但 AO-CS 患者未增加，这表明由于先前的恶性肿瘤，需要密切随访接受 GH 替代治疗的患者。
