儿童癌症幸存者患严重食管狭窄的风险--斯堪的纳维亚半岛儿童癌症后成人生活(ALiCCS)中的一项基于人群的病例队列研究

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摘要

目的 由于儿童癌症幸存者中与食管狭窄相关的治疗相关风险因素的数据有限,本研究旨在评估长期幸存者中的此类因素。方法 进行了一项病例队列研究,涉及 36 例患有食管狭窄的五年期儿童癌症幸存者,以及北欧 "斯堪的纳维亚儿童癌症后的成人生活 "计划中确定的 1970-2007 年期间诊断为癌症的 540 名幸存者的子队列。从医疗记录中获取了个性化的治疗细节。我们重建了接受放射治疗的患者身体各部位的辐射剂量和食道的平均剂量。通过计算发病率比(IRR)和 95 % 置信区间(CIs),我们使用改良的 Cox 比例危险模型来评估食管狭窄与风险因素之间的关联。7,95 %CI 4.6-41.1)、胸部和颈部定向放疗(IRR=23.5,95 %CI 8.5-64.7)和食管剂量≥12 Gy(IRR=26.8,95 % CI=9.0-80.3)的幸存者的食管狭窄率高于未接受放疗的幸存者。化疗也与食管狭窄有关(IRR=8.4,95 % CI=2.9-24.4)。值得注意的是,与中枢神经系统和其他实体瘤的幸存者相比,白血病幸存者的食管狭窄发生率更高(IRR=3.8,95 % CI=1.8-8.1)。
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Risk of severe esophageal stricture among childhood cancer survivors – A population-based case-cohort study within the Adult Life after Childhood Cancer in Scandinavia (ALiCCS)

Purpose

Due to limited data on treatment-related risk factors associated with esophageal stricture in childhood cancer survivors, this study aimed to assess such factors in long-term survivors.

Methods

A case-cohort study was conducted involving 36 cases of five-year childhood cancer survivors with esophageal stricture and a sub-cohort of 540 survivors diagnosed with cancer in 1970–2007 as identified within the Nordic ‘Adult Life after Childhood Cancer in Scandinavia’ program. Individualized treatment details were retrieved from medical records. Radiation doses to each body region and average dose to the esophagus were reconstructed for patients that received radiotherapy. We used a modified Cox proportional hazard model to evaluate associations between esophageal stricture and risk factors by calculating incidence rate ratio (IRR), with 95 % confidence intervals (CIs).

Results

An increased rate of esophageal stricture was found in survivors who received total body irradiation (IRR=13.7, 95 %CI 4.6–41.1), chest- and neck-directed radiotherapy (IRR=23.5, 95 %CI 8.5−64.7) and doses of ≥12 Gy to the esophagus (IRR=26.8, 95 % CI=9.0–80.3) compared to non-irradiated survivors. Treatment with chemotherapy was also associated with esophageal stricture (IRR=8.4, 95 % CI=2.9–24.4). Notably, leukemia survivors faced an elevated rate (IRR=3.8, 95 % CI 1.8–8.1) compared with survivors of CNS and other solid tumors.

Conclusions

Our findings indicate an increased risk of esophageal stricture among childhood cancer survivors, with both neck- and chest-directed radiotherapy and chemotherapy as important risk factors.
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