Department of Health Sciences, University of York, York, UK.
Leeds Teaching Hospitals NHS Trust, Leeds, UK.
BMJ Open. 2022 Mar 7;12(3):e056216. doi: 10.1136/bmjopen-2021-056216.
To examine morbidity and mortality among teenagers and young adults (TYAs) previously diagnosed with acute lymphoblastic leukaemia (ALL) in childhood, and compare to the general TYA population.
National population-based sex-matched and age-matched case-control study converted into a matched cohort, with follow-up linkage to administrative healthcare databases.
The study population comprised all children (0-14 years) registered for primary care with the National Health Service (NHS) in England 1992-1996.
1082 5-year survivors of ALL diagnosed<15 years of age (1992-1996) and 2018 unaffected individuals; followed up to 15 March 2020.
Associations with hospital activity, cancer and mortality were assessed using incidence rate ratios (IRR) and differences.
Mortality in the 5-year ALL survivor cohort was 20 times higher than in the comparison cohort (rate ratio 21.3, 95% CI 11.2 to 45.6), and cancer incidence 10 times higher (IRR 9.9 95% CI 4.1 to 29.1). Hospital activity was increased for many clinical specialties, the strongest associations being for endocrinology; outpatient IRR 36.7, 95% CI 17.3 to 93.4 and inpatient 19.7, 95% CI 7.9 to 63.2 for males, and 11.0, 95% CI 6.2 to 21.1 and 6.2 95% CI 3.1 to 13.5, respectively, for females. Notable excesses were also evident for cardiology, neurology, ophthalmology, respiratory medicine and general medicine. Males were also more likely to attend gastroenterology; ear, nose and throat; urology; and dermatology, while females were more likely to be seen in plastic surgery and less likely in midwifery.
Adding to excess risks of death and cancer, survivors of childhood ALL experience excess outpatient and inpatient activity across their TYA years, which is not related to routine follow-up monitoring. Involving most clinical specialties, associations are striking, showing no signs of diminishing over time. Recognising that all survivors are potentially at risk of late treatment-associated effects, our findings underscore the need to take prior ALL diagnosis into account when interpreting seemingly unrelated symptoms later in life.
研究先前被诊断患有急性淋巴细胞白血病（ALL）的青少年和年轻人（TYA）的发病率和死亡率，并与一般 TYA 人群进行比较。
全国范围内基于人群的性别匹配和年龄匹配的病例对照研究转化为匹配队列，通过与行政医疗保健数据库进行随访链接。
该研究人群包括所有在英格兰（1992-1996 年）注册初级保健的儿童（0-14 岁）。
1082 名 5 岁以下 ALL 幸存者，年龄<15 岁（1992-1996 年）和 2018 名未受影响的个体；随访至 2020 年 3 月 15 日。
使用发病率比（IRR）和差异评估与医院活动、癌症和死亡率的相关性。
ALL 幸存者队列的死亡率是对照组的 20 倍（比率比 21.3，95%置信区间 11.2 至 45.6），癌症发病率高 10 倍（IRR 9.9，95%置信区间 4.1 至 29.1）。许多临床专业的医院活动增加，最强的关联是内分泌学；门诊 21.7，95%置信区间 17.3 至 93.4 和住院 19.7，95%置信区间 7.9 至 63.2 为男性，11.0，95%置信区间 6.2 至 21.1 和 6.2，95%置信区间 3.1 至 13.5 分别为女性。在心脏病学、神经病学、眼科学、呼吸医学和普通医学中也明显存在过多的情况。男性也更有可能接受胃肠病学、耳鼻喉科、泌尿科和皮肤科的治疗，而女性更有可能接受整形手术，接受妇产科的治疗则较少。
除了死亡和癌症的风险增加之外，儿童 ALL 的幸存者在整个青少年时期都经历了门诊和住院治疗的过度治疗，这与常规随访监测无关。涉及大多数临床专业，关联引人注目，且随着时间的推移没有减弱的迹象。由于认识到所有幸存者都可能面临晚期治疗相关影响的风险，因此我们的研究结果强调了在以后的生活中解释看似无关的症状时，需要考虑先前的 ALL 诊断。
