儿童癌症幸存者在被诊断出患有乳腺癌、黑色素瘤或结直肠癌后，整体生存率明显较差。
Childhood cancer survivors face markedly worse overall survival after diagnosis with breast cancer, melanoma, or colorectal cancer.
机构信息
Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Public Health Sciences, University of Virginia Cancer Center, Charlottesville, Virginia, USA.
出版信息
J Surg Oncol. 2021 Jul;124(1):16-24. doi: 10.1002/jso.26478. Epub 2021 Mar 31.
BACKGROUND
Childhood cancer survivors (CCS) are at elevated risk of secondary malignancies (SM). Enhanced screening for SM is recommended, but compliance is poor. We hypothesized that CCS with adult-onset SM (colorectal cancer [CRC], melanoma, or breast cancer [BC]) would present with more advanced disease and have decreased overall survival (OS).
METHODS
The Surveillance, Epidemiology, and End Results Program was queried for patients diagnosed with cancer at age less than or equal to 18 also diagnosed with adult-onset CRC, melanoma, or BC. A cohort without a history of prior malignancy was likewise identified. Tumor features and clinical outcomes were compared.
RESULTS
CCS with a SM (n = 224) were compared with patients without a childhood cancer history (n = 1,392,670). CCS were diagnosed younger (BC = 37.6 vs. 61.3, p < 0.01, CRC = 35.0 vs. 67.1, p < 0.01, melanoma = 29.6 vs. 61.3 years old, p < 0.01). CCS with BC were more likely to have Stage III or IV disease (25.2% vs. 16.5%, p = 0.01). Hormone-receptor expression also differed; CCS were less likely to develop Luminal A-type tumors (48.6% vs. 66.9%, p = 0.01). After age-adjustment, CCS had worse OS (Hazard ratio: CRC = 2.449, p < 0.01, melanoma = 6.503, p < 0.01, BC = 3.383, p < 0.01).
CONCLUSION
CCS were younger when diagnosed with a SM. After age-adjustment, OS was diminished. Heightened surveillance may be necessary for CCS diagnosed with SM.
背景
儿童癌症幸存者（CCS）发生继发性恶性肿瘤（SM）的风险增加。建议对 SM 进行强化筛查，但依从性很差。我们假设患有成人期 SM（结直肠癌 [CRC]、黑色素瘤或乳腺癌 [BC]）的 CCS 会出现更晚期的疾病，并且总体生存率（OS）降低。
方法
查询 Surveillance, Epidemiology, and End Results Program 数据库，以确定在 18 岁及以下被诊断患有 CRC、黑色素瘤或 BC 的癌症患者。同样确定了没有先前恶性肿瘤史的队列。比较了肿瘤特征和临床结果。
结果
将患有 SM 的 CCS（n=224）与没有儿童癌症病史的患者（n=1,392,670）进行比较。CCS 的诊断年龄更小（BC=37.6 岁 vs. 61.3 岁，p<0.01，CRC=35.0 岁 vs. 67.1 岁，p<0.01，黑色素瘤=29.6 岁 vs. 61.3 岁，p<0.01）。患有 BC 的 CCS 更有可能患有 III 或 IV 期疾病（25.2% vs. 16.5%，p=0.01）。激素受体表达也不同；CCS 不太可能发展为 Luminal A 型肿瘤（48.6% vs. 66.9%，p=0.01）。在年龄调整后，CCS 的 OS 更差（风险比：CRC=2.449，p<0.01，黑色素瘤=6.503，p<0.01，BC=3.383，p<0.01）。
结论
CCS 在诊断出 SM 时年龄较小。在年龄调整后，OS 降低。对诊断出 SM 的 CCS 可能需要进行强化监测。
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