Reulen Raoul C, Wong Kwok F, Bright Chloe J, Winter David L, Alessi Daniela, Allodji Rodrigue M, Bagnasco Francesca, Bárdi Edit, Bautz Andrea, Byrne Julianne, Feijen Elizabeth Am, Fidler-Benaoudia Miranda M, Diallo Ibrahim, Garwicz Stanislaw, Grabow Desiree, Gudmundsdottir Thorgerdur, Guha Joyeeta, Haddy Nadia, Høgsholt Stine, Jankovic Moncilo, Kaatsch Peter, Kaiser Melanie, Kuonen Rahel, Linge Helena, Øfstaas Hilde, Ronckers Cecile M, Hau Eva-Maria, Skinner Roderick, van Leeuwen Flora E, Teepen Jop C, Veres Cristina, Zrafi Wael, Debiche Ghazi, Llanas Damien, Terenziani Monica, Vu-Bezin Giao, Wesenberg Finn, Wiebe Thomas, Sacerdote Carlotta, Jakab Zsuzsanna, Haupt Riccardo, Lähteenmäki Päivi M, Zadravec Zaletel Lorna, Kuehni Claudia E, Winther Jeanette F, de Vathaire Florent, Kremer Leontien C, Hjorth Lars, Hawkins Michael M
Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK.
National Cancer Registration and Analysis Service, Public Health England, London, UK.
Gut. 2020 Nov 2. doi: 10.1136/gutjnl-2020-322237.
Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide.
The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence.
427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected.
Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
儿童癌症幸存者有患后续原发性肿瘤（SPN）的风险，但40岁以后患特定消化系统SPN的风险仍不确定。我们在全球最大的可用队列中调查了特定消化系统SPN的风险。
泛癌生存随访队列包括来自欧洲12个国家的69460名儿童癌症五年幸存者。使用标准化发病率（SIR）、绝对超额风险和累积发病率对消化系统SPN的风险进行量化。
413名幸存者中诊断出427例消化系统SPN（214例结直肠癌、62例肝癌、48例胃癌、44例胰腺癌、59例其他）。肾母细胞瘤（WT）和霍奇金淋巴瘤（HL）幸存者风险最高（SIR分别为12.1；95%CI 9.6至15.1；SIR 7.3；95%CI 5.9至9.0）。WT幸存者的累积发病率随年龄增长上升最为陡峭，到55岁时达到7.4%，60岁时达到9.6%（基于一般人群发病率预期为1.0%）。关于结直肠癌SPN，WT和HL幸存者风险最高；均为预期风险的7倍。到55岁时，WT（95%CI 1.4至3.9）和HL（95%CI 1.6至3.2）幸存者中均有2.3%发生了结直肠癌SPN，这与至少有两名一级亲属患癌的一般人群成员的风险相当。
在许多欧洲国家，建议有结直肠癌家族史的个体在55岁前进行结肠镜监测，但对于WT和HL幸存者不建议，尽管他们的风险状况相当。临床上，应认真考虑实施结肠镜监测，同时对WT和HL幸存者进行其益处、危害和成本效益的进一步评估。
