1641例儿童和青少年期诊断的霍奇金淋巴瘤患者后续发生恶性肿瘤的风险：一项基于北欧五国人群的队列研究。北欧癌症登记协会与北欧儿科血液学和肿瘤学会合作开展。

Risk of subsequent malignant neoplasms among 1,641 Hodgkin's disease patients diagnosed in childhood and adolescence: a population-based cohort study in the five Nordic countries. Association of the Nordic Cancer Registries and the Nordic Society of Pediatric Hematology and Oncology.

作者信息

Sankila R, Garwicz S, Olsen J H, Döllner H, Hertz H, Kreuger A, Langmark F, Lanning M, Möller T, Tulinius H

机构信息

Finnish Cancer Registry, Helsinki, Finland.

出版信息

J Clin Oncol. 1996 May;14(5):1442-6. doi: 10.1200/JCO.1996.14.5.1442.

DOI:10.1200/JCO.1996.14.5.1442

PMID:8622057

Abstract

PURPOSE

To assess the risk of subsequent malignant neoplasms among Hodgkin's disease patients diagnosed before 20 years of age in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden).

PATIENTS AND METHODS

There were 1,641 Hodgkin's disease patients identified through the national cancer registries since the 1940s or 1950s. The patients were monitored for 17,000 person-years until the end of 1991. Expected figures were derived from the age-specific incidence rates in each country and standardized incidence ratios (SIR) were calculated.

RESULTS

A total of 62 subsequent neoplasms were diagnosed (SIR, 7.7; 95% confidence interval [CI], 5.9 to 9.9). The overall cumulative risk of subsequent neoplasms was 1.9% at the 10-year follow-up point, 6.9% at 20 years, and 18% at 30 years. There were 26 subsequent neoplasms among males (SIR, 6.5; 95% CI, 4.3 to 9.6) and 36 among females (SIR, 8.9; 95% CI, 6.2 to 12), of which 16 were breast cancers (SIR, 17; 95% CI, 9.9 to 28). High risks were seen for thyroid cancer (SIR, 33; 95% CI, 15 to 62), for secondary leukemia (SIR, 17; 95% CI, 6.9 to 35), and for non-Hodgkin's lymphoma (SIR, 15; 95% CI, 4.9 to 35). The relative risk increased from 3.3 (95% CI, 1.2 to 7.1) for Hodgkin's disease patients diagnosed in the 1940s and 1950s to 15 (95% CI, 7.4 to 27) in the 1980s. The highest risk of secondary leukemia (SIR, 68; 95% CI, 18 to 174) was seen among those diagnosed with Hodgkin's disease in the 1980s.

CONCLUSION

Patients who survive Hodgkin's disease at a young age are at very high relative risk of subsequent malignant neoplasms throughout their lives. In particular, the high relative risk of breast cancer following Hodgkin's disease in the teenage years calls for enhanced activity for early diagnosis.

摘要

目的

评估北欧五国（丹麦、芬兰、冰岛、挪威和瑞典）20岁前确诊的霍奇金淋巴瘤患者发生后续恶性肿瘤的风险。

患者与方法

自20世纪40年代或50年代以来，通过国家癌症登记处识别出1641例霍奇金淋巴瘤患者。对这些患者进行了17000人年的监测，直至1991年底。预期数据来自各国的年龄特异性发病率，并计算了标准化发病率比值（SIR）。

结果

共诊断出62例后续肿瘤（SIR，7.7；95%置信区间[CI]，5.9至9.9）。在10年随访时，后续肿瘤的总体累积风险为1.9%，20年时为6.9%，30年时为18%。男性中有26例后续肿瘤（SIR，6.5；95%CI，4.3至9.6），女性中有36例（SIR，8.9；95%CI，6.2至12），其中16例为乳腺癌（SIR，17；95%CI，9.9至28）。甲状腺癌（SIR，33；95%CI，15至62）、继发性白血病（SIR，17；95%CI，6.9至35）和非霍奇金淋巴瘤（SIR，15；95%CI，4.9至35）的风险较高。20世纪40年代和50年代确诊的霍奇金淋巴瘤患者的相对风险为3.3（95%CI，1.2至7.1），到20世纪80年代增至15（95%CI，7.4至27）。20世纪80年代确诊为霍奇金淋巴瘤的患者中，继发性白血病的风险最高（SIR，68；95%CI，18至174）。