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人乳头瘤病毒相关的儿童癌症幸存者后续恶性肿瘤。

Human papillomavirus-associated subsequent malignant neoplasms among childhood cancer survivors.

机构信息

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Sichuan 610041, China.

Breast Center, West China Hospital, Sichuan University, Sichuan, China.

出版信息

Cancer Epidemiol. 2024 Oct;92:102646. doi: 10.1016/j.canep.2024.102646. Epub 2024 Aug 12.

Abstract

OBJECTIVE

Emerging evidence suggests a higher risk of human papillomavirus-associated subsequent malignant neoplasms (HPV-SMNs) in childhood cancer survivors. However, comprehensive population-based risk estimates for HPV-SMNs are lacking.

METHODS

We utilized longitudinal data obtained from the Surveillance, Epidemiology, and End Results program between 1975 and 2018 to establish a cohort comprising childhood cancer individuals who survived for at least 5 years. Standardized incidence ratio (SIR) with corresponding 95 % confidence interval (95 %CI) was used to evaluate the relative risk of HPV-SMNs. The competing risk regression model was performed to identify risk factors associated with HPV-SMNs.

RESULTS

A total of 35,397 childhood cancer survivors were included. Among them, 42 individuals subsequently developed HPV-SMNs (median time from primary cancer, 25 years). HPV-SMN anatomic sites included cervix (N=16), oropharynx (N=15), anus (N=5), vulva\vagina (N=5), and penis (N=1). The 40-year cumulative incidence rate of HPV-SMNs was estimated to be 0.51 %. All survivors had a 10-fold increased risk of developing HPV-SMNs compared to individuals of similar age in the general population (SIR 10.1, 95 %CI 7.3-13.6). The competing risk regression model indicted that age at diagnosis and the type of primary malignancy could potentially influence the development of HPV-SMNs. Furthermore, multivariable Cox regression analysis confirmed that the presence of HPV-SMNs significantly increased the risk of mortality for survivors (hazard ratio 2.63, 95 %CI 1.68-4.14).

CONCLUSIONS

Childhood cancer survivors have a significantly elevated risk of developing HPV-SMNs, accompanied by poor survival outcomes. Encouraging HPV vaccination and robust surveillance protocols may improve long-term health outcomes in childhood cancer survivors.

摘要

目的

新出现的证据表明,儿童癌症幸存者发生人乳头瘤病毒相关后续恶性肿瘤(HPV-SMN)的风险更高。然而,目前缺乏基于人群的 HPV-SMN 全面风险估计。

方法

我们利用 1975 年至 2018 年期间从监测、流行病学和最终结果计划中获得的纵向数据,建立了一个由至少存活 5 年的儿童癌症个体组成的队列。使用标准化发病比(SIR)及其相应的 95%置信区间(95%CI)来评估 HPV-SMN 的相对风险。使用竞争风险回归模型来确定与 HPV-SMN 相关的风险因素。

结果

共纳入 35397 名儿童癌症幸存者。其中,42 名个体随后发生 HPV-SMN(从原发性癌症到中位时间为 25 年)。HPV-SMN 的解剖部位包括宫颈(N=16)、口咽(N=15)、肛门(N=5)、外阴/阴道(N=5)和阴茎(N=1)。HPV-SMN 的 40 年累积发生率估计为 0.51%。与同龄人群相比,所有幸存者发生 HPV-SMN 的风险增加了 10 倍(SIR 10.1,95%CI 7.3-13.6)。竞争风险回归模型表明,诊断时的年龄和原发性恶性肿瘤的类型可能会影响 HPV-SMN 的发展。此外,多变量 Cox 回归分析证实,HPV-SMN 的存在显著增加了幸存者的死亡风险(危险比 2.63,95%CI 1.68-4.14)。

结论

儿童癌症幸存者发生 HPV-SMN 的风险显著增加,生存结局较差。鼓励 HPV 疫苗接种和严格的监测方案可能会改善儿童癌症幸存者的长期健康结局。

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