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Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study.
J Natl Cancer Inst 2001; 93(8):618-29JNCI

Abstract

BACKGROUND

Because survival rates among childhood cancer patients are increasing, assessing the risk of second and subsequent malignant neoplasms (SMNs) is ever more important. Using the Childhood Cancer Survivor Study cohort, we identified the risk of SMNS:

METHODS

A retrospective cohort of 13 581 children diagnosed with common cancers before age 21 years and surviving at least 5 years was constructed with the use of data from patients treated at 25 U.S. and Canadian institutions. SMNs were ascertained through self-administered questionnaires and verified by pathology reports. Information on therapeutic exposures was abstracted from medical records. The risk of SMN was evaluated by standardized incidence ratios (SIRs) and excess absolute risk. Poisson multiple regression models were used to assess the impact of host and therapy factors on the risk of developing SMNS: All statistical tests were two-sided.

RESULTS

In 298 individuals, 314 SMNs were identified (SIR = 6.38; 95% confidence interval [CI] = 5.69 to 7.13). The largest observed excess SMNs were bone and breast cancers (SIR = 19.14 [95% CI = 12.72 to 27.67] and SIR = 16.18 [95% CI = 12.35 to 20.83], respectively). A statistically significant excess of SMNs followed all childhood cancers. In multivariate regression models adjusted for therapeutic radiation exposure, SMNs of any type were independently associated with female sex (P<.001), childhood cancer at a younger age (P for trend <.001), childhood Hodgkin's disease or soft-tissue sarcoma (P<.001 and P =.01, respectively), and exposure to alkylating agents (P for trend =.02). Twenty years after the childhood cancer diagnosis, the cumulative estimated SMN incidence was 3.2%. However, only 1.88 excess malignancies occurred per 1000 years of patient follow-up.

CONCLUSIONS

Success in treating children with cancer should not be overshadowed by the incidence of SMNS: However, patients and health-care providers must be aware of risk factors for SMNs so that surveillance is focused and early prevention strategies are implemented.

Authors+Show Affiliations

Department of Pediatrics, University of Minnesota School of Medicine, 420 Delaware St., Minneapolis, MN 55455, USA. jneglia@tc.umn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11309438

Citation

Neglia, J P., et al. "Second Malignant Neoplasms in Five-year Survivors of Childhood Cancer: Childhood Cancer Survivor Study." Journal of the National Cancer Institute, vol. 93, no. 8, 2001, pp. 618-29.
Neglia JP, Friedman DL, Yasui Y, et al. Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. J Natl Cancer Inst. 2001;93(8):618-29.
Neglia, J. P., Friedman, D. L., Yasui, Y., Mertens, A. C., Hammond, S., Stovall, M., ... Robison, L. L. (2001). Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. Journal of the National Cancer Institute, 93(8), pp. 618-29.
Neglia JP, et al. Second Malignant Neoplasms in Five-year Survivors of Childhood Cancer: Childhood Cancer Survivor Study. J Natl Cancer Inst. 2001 Apr 18;93(8):618-29. PubMed PMID: 11309438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. AU - Neglia,J P, AU - Friedman,D L, AU - Yasui,Y, AU - Mertens,A C, AU - Hammond,S, AU - Stovall,M, AU - Donaldson,S S, AU - Meadows,A T, AU - Robison,L L, PY - 2001/4/20/pubmed PY - 2001/6/8/medline PY - 2001/4/20/entrez SP - 618 EP - 29 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 93 IS - 8 N2 - BACKGROUND: Because survival rates among childhood cancer patients are increasing, assessing the risk of second and subsequent malignant neoplasms (SMNs) is ever more important. Using the Childhood Cancer Survivor Study cohort, we identified the risk of SMNS: METHODS: A retrospective cohort of 13 581 children diagnosed with common cancers before age 21 years and surviving at least 5 years was constructed with the use of data from patients treated at 25 U.S. and Canadian institutions. SMNs were ascertained through self-administered questionnaires and verified by pathology reports. Information on therapeutic exposures was abstracted from medical records. The risk of SMN was evaluated by standardized incidence ratios (SIRs) and excess absolute risk. Poisson multiple regression models were used to assess the impact of host and therapy factors on the risk of developing SMNS: All statistical tests were two-sided. RESULTS: In 298 individuals, 314 SMNs were identified (SIR = 6.38; 95% confidence interval [CI] = 5.69 to 7.13). The largest observed excess SMNs were bone and breast cancers (SIR = 19.14 [95% CI = 12.72 to 27.67] and SIR = 16.18 [95% CI = 12.35 to 20.83], respectively). A statistically significant excess of SMNs followed all childhood cancers. In multivariate regression models adjusted for therapeutic radiation exposure, SMNs of any type were independently associated with female sex (P<.001), childhood cancer at a younger age (P for trend <.001), childhood Hodgkin's disease or soft-tissue sarcoma (P<.001 and P =.01, respectively), and exposure to alkylating agents (P for trend =.02). Twenty years after the childhood cancer diagnosis, the cumulative estimated SMN incidence was 3.2%. However, only 1.88 excess malignancies occurred per 1000 years of patient follow-up. CONCLUSIONS: Success in treating children with cancer should not be overshadowed by the incidence of SMNS: However, patients and health-care providers must be aware of risk factors for SMNs so that surveillance is focused and early prevention strategies are implemented. SN - 0027-8874 UR - https://www.unboundmedicine.com/medline/citation/11309438/Second_malignant_neoplasms_in_five_year_survivors_of_childhood_cancer:_childhood_cancer_survivor_study_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/93.8.618 DB - PRIME DP - Unbound Medicine ER -