Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Unit of Statistics and Pharmaco-epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.
Acta Oncol. 2020 Oct;59(10):1246-1256. doi: 10.1080/0284186X.2020.1794031. Epub 2020 Jul 21.
In the 1960s only 1/3 of children with soft-tissue sarcomas survived, however with improved treatments survival today has reached 70%. Given the previous poor survival and the rarity of soft-tissue sarcomas, the risk of somatic late effects in a large cohort of Nordic soft-tissue sarcoma survivors has not yet been assessed.
In this population-based cohort study we identified 985 five-year soft-tissue sarcoma survivors in Nordic nationwide cancer registries and late effects in national hospital registries covering the period 1964-2012. Information on tumour site and radiotherapy was available for Danish and Finnish survivors ( = 531). Using disease-specific rates of first-time hospital contacts for somatic diseases in survivors and in 4,830 matched comparisons we calculated relative rates (RR) and rate differences (RD).
Survivors had a RR of 1.5 (95% CI 1.4-1.7) and an absolute RD of 23.5 (17.7-29.2) for a first hospital contact per 1,000 person-years. The highest risks in both relative and absolute terms were of endocrine disorders (RR = 2.5; RD = 7.6), and diseases of the nervous system (RR = 1.9; RD = 6.6), digestive organs (RR = 1.7; RD = 5.4) and urinary system (RR = 1.7; RD = 5.6). By tumour site, excess risk was lower after extremity tumours. Irradiated survivors had a 2.6 (1.2-5.9) times higher risk than non-irradiated.
Soft-tissue sarcoma survivors have an increased risk of somatic late effects in 5 out of 10 main diagnostic groups of diseases, and the risk remains increased up to 40 years after cancer diagnosis. Risks were slightly lower for those treated for tumours in the extremities, and radiotherapy increased the risk by more than two-fold.
20 世纪 60 年代，仅有 1/3 的软组织肉瘤患儿存活，然而，随着治疗方法的改进，如今的存活率已达到 70%。鉴于过去的生存率较低，以及软组织肉瘤的罕见性，北欧软组织肉瘤幸存者的大量队列尚未评估其躯体迟发性效应的风险。
在这项基于人群的队列研究中，我们在北欧全国癌症登记处确定了 985 名五年软组织肉瘤幸存者，并在 1964 年至 2012 年期间涵盖的国家医院登记处中评估了迟发性效应。丹麦和芬兰幸存者（n=531）的肿瘤部位和放疗信息可用。我们使用幸存者中针对特定疾病的首次因躯体疾病而住院就诊的疾病特异性率和 4830 名匹配对照，计算了相对风险（RR）和率差（RD）。
幸存者每 1000 人年因躯体疾病首次住院的 RR 为 1.5（95%CI 1.4-1.7），绝对 RD 为 23.5（17.7-29.2）。相对和绝对风险最高的疾病是内分泌紊乱（RR=2.5；RD=7.6），以及神经系统疾病（RR=1.9；RD=6.6）、消化系统疾病（RR=1.7；RD=5.4）和泌尿系统疾病（RR=1.7；RD=5.6）。按肿瘤部位划分，四肢肿瘤患者的超额风险较低。与未接受放疗的患者相比，接受放疗的幸存者发生风险增加 2.6 倍（1.2-5.9）。
软组织肉瘤幸存者有 5 种主要诊断疾病组中的 10 种发生躯体迟发性效应的风险增加，并且在癌症诊断后长达 40 年仍保持增加。四肢肿瘤患者的风险略低，放疗使风险增加两倍以上。
