Liu Jason J, Chen Chuan-Yu, Giovannucci Edward, Wu Chun-Ying
Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Am J Gastroenterol. 2021 May 1;116(5):1063-1071. doi: 10.14309/ajg.0000000000001133.
Among survivors from first primary cancers that occurred during childhood and adolescence, their risks of developing subsequent primary digestive system cancers are not well understood. Therefore, we conducted the largest and most comprehensive analysis examining risks for diverse types of digestive system cancers after survival from a wide variety of first primary childhood and adolescent cancers.
We identified 41,249 patients diagnosed with first primary cancer from 1975 to 2015 before 20 years of age from 9 Surveillance, Epidemiology and End Results Program registries. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) for digestive system cancers were calculated controlling for age, sex, race, and calendar year.
Among 41,249 cancer survivors, 133 developed subsequent primary digestive system cancer, with a median digestive system cancer diagnosis age of 37 years. The SIR and AER for any digestive system cancer were highest among survivors of bone cancer, lymphoma, and neuroblastoma. Among survivors from any first primary cancer, the SIR was significantly elevated for cancer of the esophagus, stomach, small intestine, large intestine, liver, and pancreas, whereas the AER was highest for large intestine cancer.
Childhood and adolescent cancer survivors diagnosed from 1975 to 2015 have significantly elevated risks of digestive system cancers compared with the US general population. Our detailed findings may contribute to surveillance recommendations of childhood and adolescent cancer survivors and promote future studies to further understand mechanisms by which having various first primary cancers lead to subsequent primary digestive system cancers.
在儿童期和青春期发生的首例原发性癌症幸存者中，其患后续原发性消化系统癌症的风险尚不清楚。因此，我们进行了规模最大、最全面的分析，以研究在多种儿童期和青春期首例原发性癌症存活后，患各种类型消化系统癌症的风险。
我们从9个监测、流行病学和最终结果计划登记处确定了1975年至2015年期间20岁之前被诊断为首例原发性癌症的41249名患者。计算消化系统癌症的标准化发病率（SIRs）和绝对超额风险（AERs），并对年龄、性别、种族和日历年份进行控制。
在41249名癌症幸存者中，133人患了后续原发性消化系统癌症，消化系统癌症诊断的中位年龄为37岁。骨癌、淋巴瘤和神经母细胞瘤幸存者中任何消化系统癌症的SIR和AER最高。在任何首例原发性癌症的幸存者中，食管癌、胃癌、小肠癌、大肠癌、肝癌和胰腺癌的SIR显著升高，而大肠癌的AER最高。
与美国普通人群相比，1975年至2015年诊断出的儿童期和青春期癌症幸存者患消化系统癌症的风险显著升高。我们的详细研究结果可能有助于制定儿童期和青春期癌症幸存者的监测建议，并促进未来的研究，以进一步了解患各种首例原发性癌症导致后续原发性消化系统癌症的机制。
