Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Cancer. 2020 Jul 1;126(13):3102-3113. doi: 10.1002/cncr.32885. Epub 2020 Apr 16.
The objectives of this study were to characterize the risk of death (1) from the primary cancer vs competing cause of death; and (2) from various causes of death vs the general poplation. The relative risk of death after a pediatric cancer diagnosis versus the general population and the risk of death from a primary cancer diagnosis versus competing causes of death.
This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database (1980-2015) and included patients aged 0 to 19 years at the time of diagnosis. Observed deaths were calculated; the risk of death versus the general population was assessed with standardized mortality ratios (SMRs). Competing risk models for the cause of death were performed.
There were 58,356 patients who were diagnosed, and the mortality rate was 22.8%. To assess causes of death, 6996 patients who died during the study period were included (45,580 total person-years at risk): 5128 (73%) died of their primary cancer, and 1868 (27%) died of a competing cause. Among all patients, the rate of death from the index cancer was higher than the rate of death from another cause within the first 5 years after diagnosis. The risk of death from a nonprimary cancer began to supersede the rate of death from the primary cancer 10 years after diagnosis for patients with germ cell tumors, lymphomas, and sarcomas. SMRs for the primary cancer were highest within the first 5 years after diagnosis for all cancers (SMRs, 100-50,000; P < .0001). The risk of death from competing causes (heart disease, suicide, and sepsis) was elevated (SMR, >100; P < .001). The risk of dying of heart disease was high, especially for patients with astrocytomas (SMR, 47.84; 95% confidence interval [CI], 27.87-76.59) and neuroblastomas (SMR, 98.59; 95% CI, 47.28-181.32). The risk of dying of suicide was high in most patients, particularly for those with osteosarcomas (SMR, 111.40; 95% CI, 2.82-620.69), Hodgkin lymphomas (SMR, 62.35; 95% CI, 34.89-102.83), and gonadal germ cell tumors (SMR, 28.97; 95% CI, 12.51-57.09).
The cause of death for patients with gonadal germ cell tumors, lymphomas, and sarcomas is more commonly a secondary cancer or noncancerous cause than the primary disease; their risk of death from competing causes (heart disease, suicide, and sepsis) rises throughout life.
本研究的目的是描述（1）原发癌症与其他死因的死亡风险；以及（2）各种死因与普通人群的死亡风险。与普通人群相比，儿科癌症诊断后的死亡相对风险以及原发性癌症诊断后的死亡风险与竞争原因。
本回顾性基于人群的研究使用了监测、流行病学和最终结果数据库（1980-2015 年），并纳入了诊断时年龄在 0 至 19 岁的患者。计算观察到的死亡人数；使用标准化死亡率比（SMR）评估与普通人群相比的死亡风险。对死因进行了竞争风险模型分析。
共有 58356 名患者被诊断，死亡率为 22.8%。为了评估死因，纳入了在研究期间死亡的 6996 名患者（总风险人数为 45580 人年）：5128 名（73%）死于原发性癌症，1868 名（27%）死于竞争原因。在所有患者中，诊断后前 5 年内死于指数癌症的比率高于其他原因导致的死亡比率。对于生殖细胞瘤、淋巴瘤和肉瘤患者，诊断后 10 年内，非原发性癌症导致死亡的风险开始超过原发性癌症导致死亡的风险。所有癌症的原发性癌症 SMR 在诊断后 5 年内最高（SMR，100-50000；P<.0001）。竞争原因（心脏病、自杀和败血症）导致的死亡风险升高（SMR>100；P<.001）。心脏病死亡风险很高，尤其是患有星形细胞瘤的患者（SMR，47.84；95%置信区间 [CI]，27.87-76.59）和神经母细胞瘤（SMR，98.59；95%CI，47.28-181.32）。大多数患者自杀死亡风险很高，尤其是骨肉瘤（SMR，111.40；95%CI，2.82-620.69）、霍奇金淋巴瘤（SMR，62.35；95%CI，34.89-102.83）和性腺生殖细胞瘤（SMR，28.97；95%CI，12.51-57.09）患者。
生殖细胞瘤、淋巴瘤和肉瘤患者的死亡原因更常见的是继发性癌症或非癌症原因，而非原发性疾病；他们因竞争原因（心脏病、自杀和败血症）而死亡的风险在整个生命周期中都会上升。
