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幼児がんの生存者における長期的な特定原因による死亡率
Raoul C Reulen1, David L Winter, Clare Frobisher
1Centre for Childhood Cancer Survivor Studies, School of Health and Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, England. r.c.reulen@bham.ac.uk
JAMA
|July 15, 2010
まとめ
幼児がんの生存者は,診断から数十年後でも,特に第2のがんや循環器疾患による長期的な死亡リスクの増加に直面しています. この研究は,これらの生存者の25年を超えた死亡のリスクが持続し,上昇していることを強調しています.
科学分野:
- 腫瘍学 腫瘍学
- エピデミオロジー エピデミオロジー
- 公衆衛生は公衆衛生である.
背景:
- 幼児がんの生存者は,一般の人々よりも早めの死亡率が高くなります.
- 特定の死因の長期的なリスク,特に診断後25年を超えては,まだ十分に調査されていない.
研究 の 目的:
- 5歳児がん生存者の大きなコホートにおける長期的,特定原因による死亡パターンを調査する.
- 幼児がんの生存者における死亡リスクを理解するために,後期のライフステージ.
主な方法:
- イギリスの小児がん生存者研究 (British Childhood Cancer Survivor Study) を利用し,人口ベースのコホートを作りました.
- 15歳未満で診断された5歳生存者17,981人を含む (1940年−1991年),2006年まで追跡された.
- 原因別標準死亡率 (SMR) と絶対過剰リスク (AER) を分析した.
主要な成果:
- 全体的な死亡率は予想より11倍高かった (SMR 10.7).
- 再発リスクは時間の経過とともに減少したものの,第2次原発がんや循環器疾患のリスクは,診断後45年を超えて大幅に増加した.
- 45歳以上では,第二発がんや循環器疾患が77%を占め,再発による死亡率は7%だった.
結論:
- 第2次原発がんおよび循環器疾患による過剰死亡率は,診断後 (25歳を超えて) 長い間,小児がんの生存者において持続しています.
- 死因の遅発は,長期の生存者ケアとフォローアップ戦略の重要な考慮事項です.
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