Birdwell S H, Hancock S L, Varghese A, Cox R S, Hoppe R T
Department of Radiation Oncology, Stanford University School of Medicine, CA 94305-5105, USA.
Int J Radiat Oncol Biol Phys. 1997 Jan 1;37(1):67-73. doi: 10.1016/s0360-3016(96)00489-0.
This study aimed to quantify the risk of gastrointestinal cancer following Hodgkin's disease treatment according to age at treatment, type of treatment, and anatomic sites.
Cases were identified from the records of 2,441 patients treated for Hodgkin's disease between 1961 and 1994. Follow-up averaged 10.9 years, representing 26,590 person-years of observation. Relative risks (RR) for gastrointestinal cancer incidence and mortality were computed by comparison with expected annualized rates for a general population matched for age, sex, and race.
Gastrointestinal cancers developed in 25 patients. The incidence RR was 2.5 [95% confidence interval (CI), 1.5-3.5] and mortality RR was 3.8 (CI, 2.4-4.7). Sites associated with significantly increased risks included the stomach [RR 7.3 (CI, 3.4-13.8)], small intestine [RR 11.6 (CI, 1.9-38.3)], and pancreas [RR 3.5 (CI, 1.1-8.5)]. Risk was significantly elevated after combined modality therapy, RR 3.9 (CI, 2.2-5.6). The risk after radiotherapy alone was 2.0 (CI, 1.0-3.4), not a statistically significant elevation. The RR for gastrointestinal cancer was greatest after treatment at young age and decreased with advancing age. It was significantly elevated within 10 years after treatment [RR 2.0 (CI, 1.1-3.5)] and increased further after 20 years [RR 6.1 (CI, 2.5-12.7)]. Risk assessed by attained age paralleled risk according to age at treatment. Fifteen cases of gastrointestinal cancers arose within the irradiation fields.
Patients treated for Hodgkin's disease are at modestly increased risk for secondary gastrointestinal cancer, especially after combined modality therapy and treatment at a young age. Risk was highest more than 20 years after treatment, but was significantly elevated within 10 years. Gastrointestinal sites with increased risk included the stomach, pancreas, and small intestine.
本研究旨在根据治疗时的年龄、治疗类型和解剖部位，量化霍奇金病治疗后发生胃肠道癌症的风险。
从1961年至1994年间接受霍奇金病治疗的2441例患者的记录中识别病例。随访平均10.9年，代表26590人年的观察。通过与年龄、性别和种族匹配的普通人群的预期年化发病率进行比较，计算胃肠道癌症发病率和死亡率的相对风险（RR）。
25例患者发生胃肠道癌症。发病率RR为2.5[95%置信区间（CI），1.5 - 3.5]，死亡率RR为3.8（CI，2.4 - 4.7）。风险显著增加的部位包括胃[RR 7.3（CI，3.4 - 13.8）]、小肠[RR 11.6（CI，1.9 - 38.3）]和胰腺[RR 3.5（CI，1.1 - 8.5）]。综合治疗后风险显著升高，RR为3.9（CI，2.2 - 5.6）。单纯放疗后的风险为2.0（CI，1.0 - 3.4），无统计学显著升高。年轻时治疗后胃肠道癌症的RR最高，并随年龄增长而降低。治疗后10年内风险显著升高[RR 2.0（CI，1.1 - 3.5）]，20年后进一步升高[RR 6.1（CI，2.5 - 12.7）]。按达到年龄评估的风险与按治疗时年龄评估的风险平行。15例胃肠道癌症发生在照射野内。
接受霍奇金病治疗的患者发生继发性胃肠道癌症的风险适度增加，尤其是在综合治疗和年轻时治疗后。治疗后20多年风险最高，但10年内显著升高。风险增加的胃肠道部位包括胃、胰腺和小肠。
