Yasushi Ishida1, Miho Maeda2, Souichi Adachi3, Hiroko Inada4, Hiroshi Kawaguchi5, Hiroki Hori6, Atsushi Ogawa7, Kazuko Kudo8, Chikako Kiyotani9, Hiroyuki Shichino10, Takeshi Rikiishi11, Ryoji Kobayashi12, Maho Sato13, Jun Okamura14, Hiroaki Goto15, Atsushi Manabe16, Shinji Yoshinaga17, Dongmei Qiu18, Junichiro Fujimoto19, Tatsuo Kuroda20. 1. Pediatric Medical Center, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan. yaishida2009@yahoo.co.jp. 2. Department of Pediatrics, Nippon Medical School, Tokyo, Japan. 3. Department of Human Health Sciences, Kyoto University School of Medicine, Kyoto, Japan. 4. Department of Pediatrics, Kurume University School of Medicine, Kurume, Japan. 5. Department of Pediatrics, Hiroshima University Hospital, Hiroshima, Japan. 6. Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan. 7. Division of Pediatrics, Niigata Cancer Center, Niigata, Japan. 8. Division of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan. 9. Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan. 10. Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan. 11. Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan. 12. Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan. 13. Division of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. 14. Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan. 15. Division of Hematology-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Yokohama, Japan. 16. Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan. 17. Division of Research Center for Radiation Protection, National Institute of Radiological Science, Chiba, Japan. 18. Department of Drug Dependence Research, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan. 19. Epidemiology and Clinical Research Center for Children's Cancer, National Center for Child Health and Development, Tokyo, Japan. 20. Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUNDS: Multidisciplinary therapy has increased the risk of subsequent late effects, but detailed analyses on secondary cancers in childhood cancer survivors (CCSs) are limited in Asian countries. METHODS: This was a retrospective cohort study comprising 10,069 CCSs who were diagnosed between 1980 and 2009 across 15 Japanese hospitals. We conducted secondary analyses to estimate the incidence of secondary cancer according to each primary malignancy and to elucidate the association between primary and secondary cancers. We also explored the risk factors for the development of secondary cancer in each independent primary malignancy. RESULTS: The cumulative incidence of secondary cancer at 20 years varied among primary cancers: hematological malignancy, 3.1% (95% CI 2.2-4.3); retinoblastoma, 6.6% (95% CI 1.5-16.8); pediatric solid tumor, 2.5% (95% CI 1.3-4.2); brain tumors, 5.2% (95% CI 1.7-11.8) bone/soft tissue sarcoma, 5.2% (95% CI 2.3-10.1); and others, 3.3% (95% CI 1.6-6.0) (p = 0.015). The cumulative incidence of secondary cancers is highest in those with osteosarcoma (13.1%) followed by those with hepatoblastoma (8.4%) and retinoblastoma (6.6%). Close association between the primary and secondary cancer diagnoses was found. The risk factors for secondary cancer development depended on the primary cancer, but autologous/allogeneic stem cell transplantation was a relatively common risk factor. CONCLUSION: The cumulative incidence of secondary cancer varied among primary cancers. The primary cancer was closely associated with the secondary cancer but stem cell transplantation was a common risk factor for secondary cancers among CCSs.
BACKGROUNDS: Multidisciplinary therapy has increased the risk of subsequent late effects, but detailed analyses on secondary cancers in childhood cancer survivors (CCSs) are limited in Asian countries. METHODS: This was a retrospective cohort study comprising 10,069 CCSs who were diagnosed between 1980 and 2009 across 15 Japanese hospitals. We conducted secondary analyses to estimate the incidence of secondary cancer according to each primary malignancy and to elucidate the association between primary and secondary cancers. We also explored the risk factors for the development of secondary cancer in each independent primary malignancy. RESULTS: The cumulative incidence of secondary cancer at 20 years varied among primary cancers: hematological malignancy, 3.1% (95% CI 2.2-4.3); retinoblastoma, 6.6% (95% CI 1.5-16.8); pediatric solid tumor, 2.5% (95% CI 1.3-4.2); brain tumors, 5.2% (95% CI 1.7-11.8) bone/soft tissue sarcoma, 5.2% (95% CI 2.3-10.1); and others, 3.3% (95% CI 1.6-6.0) (p = 0.015). The cumulative incidence of secondary cancers is highest in those with osteosarcoma (13.1%) followed by those with hepatoblastoma (8.4%) and retinoblastoma (6.6%). Close association between the primary and secondary cancer diagnoses was found. The risk factors for secondary cancer development depended on the primary cancer, but autologous/allogeneic stem cell transplantation was a relatively common risk factor. CONCLUSION: The cumulative incidence of secondary cancer varied among primary cancers. The primary cancer was closely associated with the secondary cancer but stem cell transplantation was a common risk factor for secondary cancers among CCSs.
Entities:
Keywords:
Childhood cancer; Cumulative incidence; Late effects; Risk factors; Secondary cancer
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