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Di Ciaccio PR, Van Leeuwen MT, Amin J, Vajdic CM, McGregor S, Poynten IM, Templeton DJ, Law M, Grulich AE, Polizzotto MN, Jin F. Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors. J Acquir Immune Defic Syndr 2023; 93:25-33. [PMID: 36804500 PMCID: PMC10484748 DOI: 10.1097/qai.0000000000003172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Evidence regarding the characteristics of second primary cancer (SPC) in people living with HIV (PLWHIV) is limited. SETTING We performed a national population-based data linkage study to determine the incidence and risk factors of SPC in PLWHIV in Australia between 1982 and 2012. METHODS We conducted a probabilistic data linkage study to compare the incidence of SPC over time, defined using HIV treatment eras, for SPCs related to oncogenic viral infection in comparison with non-infection-related SPCs. Risk factors considered included age at diagnosis of cancer, sex, HIV exposure modality, and CD4 + count. RESULTS Of 29,383 individuals diagnosed with HIV, 3123 individuals who developed a first primary cancer were included in the analysis. Among them, 229 cases of SPC were identified across 27,398 person-years of follow-up. The most common SPCs were non-Hodgkin lymphomas (n = 71, 31%). The incidence of SPC overall did not change over time; however, there was an increase in individuals diagnosed with HIV in later eras ( P trend =0.001). The incidence of non-infection-related SPC increased over time and was associated with older age ( P trend = 0.005) and the acquisition of HIV in later eras ( P trend <0.001). Conversely, the incidence of infection-related SPC decreased ( P trend <0.001), but this was no longer significant after adjustment for age ( P trend = 0.14). CONCLUSIONS The risk of SPC in PLWHIV in Australia remains high, with a temporal increase observed in non-infection-related cancer, likely due to aging of the population. Optimal screening and prevention strategies for SPC in PLWHIV are increasingly important.
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Affiliation(s)
- Pietro R. Di Ciaccio
- Department of Haematology, Sydney Adventist Hospital, Sydney, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Marina T. Van Leeuwen
- Cancer Epidemiology Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Janaki Amin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Claire M. Vajdic
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Skye McGregor
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Isobel M. Poynten
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - David J. Templeton
- Department of Sexual Health Medicine and Sexual Assault Medicine, Sydney Local Health District, Sydney, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Matthew Law
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Andrew E. Grulich
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Mark N. Polizzotto
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
- Clinical Hub for Interventional Research, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fengyi Jin
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
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Teepen JC, Kok JL, Feijen EAM, Loonen JJ, van den Heuvel‐Eibrink MM, van der Pal HJ, Tissing WJE, Bresters D, Versluys B, Grootenhuis MA, Louwerens M, Neggers SJCMM, van Santen HM, de Vries A, Janssens GO, den Hartogh JG, van Leeuwen FE, Hollema N, Streefkerk N, Kilsdonk E, van der Heiden‐van der Loo M, van Dulmen‐den Broeder E, Ronckers CM, Kremer LCM. Questionnaire‐ and linkage‐based outcomes in Dutch childhood cancer survivors: Methodology of the
DCCSS LATER
study part 1. Cancer Med 2022; 12:7588-7602. [PMID: 36519590 PMCID: PMC10067029 DOI: 10.1002/cam4.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Childhood cancer survivors are at risk for developing long-term adverse health outcomes. To identify the risk of and risk factors for specific health outcomes, well-established cohorts are needed with detailed information on childhood cancer diagnosis, treatment, and health outcomes. We describe the design, methodology, characteristics, and data availability of the Dutch Childhood Cancer Survivor Study LATER cohort (1963-2001) part 1; questionnaire and linkage studies. METHODS The LATER cohort includes 5-year childhood cancer survivors, diagnosed in the period 1963-2001, and before the age of 18 in any of the seven former pediatric oncology centers in the Netherlands. Information on health outcomes from survivors and invited siblings of survivors was collected by questionnaires and linkages to medical registries. RESULTS In total, 6165 survivors were included in the LATER cohort. Extensive data on diagnosis and treatment have been collected. Information on a variety of health outcomes has been ascertained by the LATER questionnaire study and linkages with several registries for subsequent tumors, health care use, and hospitalizations. CONCLUSION Research with data of the LATER cohort will provide new insights into risks of and risk factors for long-term health outcomes. This can enhance risk stratification for childhood cancer survivors and inform surveillance guidelines and development of interventions to prevent (the impact of) long-term adverse health outcomes. The data collected will be a solid baseline foundation for future follow-up studies.
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Affiliation(s)
- Jop C. Teepen
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | - Judith L. Kok
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Jacqueline J. Loonen
- Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology Radboud University Medical Center Nijmegen The Netherlands
| | - Marry M. van den Heuvel‐Eibrink
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center Rotterdam The Netherlands
| | | | - Wim J. E. Tissing
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | - Birgitta Versluys
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Marloes Louwerens
- Department of Internal Medicine Leiden University Medical Center Leiden The Netherlands
| | - Sebastian J. C. M. M. Neggers
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Medicine, Erasmus Medical Center Rotterdam The Netherlands
| | - Hanneke M. van Santen
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatric Oncology/Hematology, Erasmus Medical Center Rotterdam The Netherlands
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department Radiation Oncology, University Medical Center Utrecht Utrecht The Netherlands
| | | | - Flora E. van Leeuwen
- Department of Epidemiology and Biostatistics The Netherlands Cancer Institute Amsterdam The Netherlands
| | - Nynke Hollema
- Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein The Netherlands
| | - Nina Streefkerk
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Department of Pediatrics, Erasmus Medical Center Rotterdam The Netherlands
| | - Ellen Kilsdonk
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Eline van Dulmen‐den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- Brandenburg Medical School Institute of Biostatistics and Registry Research Neuruppin Germany
| | - Leontien C. M. Kremer
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital Utrecht The Netherlands
- Emma Children's Hospital, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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3
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Bugaiski-Shaked A, Shany E, Mesner O, Sergienko R, Wainstock T. Association Between Neonatal Phototherapy Exposure and Childhood Neoplasm. J Pediatr 2022; 245:111-116. [PMID: 35120988 DOI: 10.1016/j.jpeds.2022.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To study the association between phototherapy for the treatment of neonatal jaundice and the risk of childhood neoplasms. STUDY DESIGN This population-based retrospective cohort study included all infants born at ≥32 weeks of gestation at a single medical center between 1988 and 2018. The incidence of neoplastic diseases was compared between infants exposed to phototherapy and those unexposed. Kaplan-Meier curves and log-rank tests were used for cumulative incidence comparison, and multivariable Cox and Weibull survival analysis were used to adjust for confounding or clinically significant variables. RESULTS The study population included 342 172 infants, of whom 18 797 (5.5%) were exposed to phototherapy. The median duration of follow-up was 9.5 years (range, birth to 18 years). Phototherapy was associated with a significantly increased risk for childhood malignancies and benign tumors (preterm birth and maternal age-adjusted hazard ratio, 1.89 [95% CI, 1.35-2.67] for malignancies and 1.27 [95% CI, 1.02-1.57] for benign tumors) Specifically, phototherapy was associated with hematopoietic cancers and leukemia (hazard ratio, 2.29 [95% CI, 1.48-3.54; P < .01] for hematopoietic cancers and 2.51 [95% CI, 1.52-4.14; P < .001] for leukemia), but not with solid tumors and lymphoma. CONCLUSIONS Phototherapy may be associated with a slightly increased childhood risk of neoplasm. It is important to strictly follow phototherapy treatment guidelines to minimize unnecessary exposure.
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Affiliation(s)
- Adva Bugaiski-Shaked
- Obstetrics and Gynecology Division, Soroka University Medical Center, Be'er- Sheva, Israel.
| | - Eilon Shany
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Oded Mesner
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Neonatal Department, Soroka University Medical Center, Be'er- Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Medical Computing Unit, School of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Tamar Wainstock
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Department of Public Health, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
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4
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Beijer JGM, Teepen JC, Streefkerk N, Heijnen RM, Janssens GO, Kremer LCM, van Dalen EC, Ronckers CM. Late Toxicity After 3-Dimensional External Beam Radiotherapy Among Children With Cancer: A Systematic Review. J Pediatr Hematol Oncol 2022; 44:117-134. [PMID: 35398857 DOI: 10.1097/mph.0000000000002445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Radiotherapy has evolved from 2-dimensional conventional radiotherapy (2D-RT) to 3-dimensional planned radiotherapy (3D-RT). Because 3D-RT improves conformity, an altered late health outcomes risk profile is anticipated. Here, we systematically reviewed the current literature on late toxicity after 3D-RT in children treated for cancer. PubMed was searched for studies describing late toxicity after 3D-RT for childhood cancer (below 21 y). Late toxicity was defined as somatic health outcomes occurring ≥90 days after treatment. We identified 13 eligible studies, describing most frequently head/neck area tumors. Included studies reported on crude frequencies of late toxicities including subsequent tumors and conditions of organ systems. Three studies offered a global assessment of the full spectrum of late toxicity; one study compared toxicities after 2D-RT and 3D-RT. Incidence rates were typically not provided. Heterogeneity in study characteristics, small study sizes and short follow-up times precluded multivariable modeling and pooling of data. In conclusion, among the first pediatric cohorts treated with 3D-RT, a broad variety of late toxicity is reported; precise estimates of incidence, and contributions of risk factors are unclear. Continued systematic evaluation of well-defined health outcomes in survivors treated with 3D-RT, including proton therapy, is needed to optimize evidence-based care for children with cancer and survivors.
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Affiliation(s)
| | | | | | | | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology
- Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
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5
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van Gorp M, van Erp LME, Maas A, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers CM, Bresters D, Louwerens M, van der Heiden-van der Loo M, Huizinga GA, Maurice-Stam H, Grootenhuis MA. Increased health-related quality of life impairments of male and female survivors of childhood cancer: DCCSS LATER 2 psycho-oncology study. Cancer 2021; 128:1074-1084. [PMID: 34726782 PMCID: PMC9298191 DOI: 10.1002/cncr.34003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 01/27/2023]
Abstract
Background The objective of this study was to compare the health‐related quality of life (HRQOL) of Dutch adult male and female childhood cancer survivors (CCSs) to general population references and to study medical determinants. Methods CCSs from the Dutch Childhood Cancer Survivor Study LATER cohort (1963‐2001) part 2, who were 18 years old or older (time since diagnosis ≥ 5 years), were invited to complete the TNO‐AZL Questionnaire for Adult Health‐Related Quality of Life. Domain scores and proportions of CCSs with impaired HRQOL (score < 25th percentile of the reference scores) were compared with references via Mann‐Whitney U tests and logistic regression analyses corrected for age and sex (P < .004). Interactions of group with sex were included if they were significant (P < .05). Moreover, medical determinants were analyzed with multivariable logistic regression analyses. Results HRQOL scores for 1766 CCSs (mean age, 35.9 years [standard deviation, 9.4 years]; male, 51%; response rate, 71%) differed from references on most domains with small effect sizes. Both male and female CCSs were more often impaired in gross and fine motor functioning, cognitive functioning, sleep, and vitality with odds ratios (ORs) > 1.4. In addition, female CCSs were more often impaired in daily activities, pain, and sexuality (ORs, 1.4‐1.9) and were less often aggressive (OR, 0.6). CCCs of central nervous system (CNS) tumors, bone tumors, and retinoblastoma and those with cranial, abdominopelvic, or lower extremity radiotherapy were at increased risk of impairment in 1 or more domains. Conclusions Dutch adult CCSs, especially females, have impaired HRQOL in several domains; this is most pronounced in cognitive functioning. The vulnerabilities of subgroups at risk, such as CCSs of CNS tumors, were confirmed. Surveillance of HRQOL and multidisciplinary survivor care are recommended. Lay Summary The health‐related quality of life in a Dutch nationwide cohort of 1766 survivors of childhood cancer was studied. Survivors of childhood cancer were found to have lower health‐related quality of life in several domains (eg, motor functioning and vitality) in comparison with the general population. They most often reported low cognitive functioning (eg, memory and attention). Females had low health‐related quality of life in more domains than males. Survivors of brain tumors had low health‐related quality of life in most domains. Monitoring health‐related quality of life regularly and collaborating between disciplines in survivor care is recommended.
Dutch adult survivors of childhood cancer, especially females and central nervous system tumor survivors, have impaired health‐related quality of life in several domains; this is most pronounced in cognitive functioning. Surveillance of health‐related quality of life and multidisciplinary survivor care are recommended.
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Affiliation(s)
- Marloes van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Loes M E van Erp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anne Maas
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Erasmus MC Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Willem-Alexander Children's Hospital, Leiden, the Netherlands.,Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Gea A Huizinga
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Department of Pediatric Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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6
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Kruseová J, Gottfriedová B, Zichová A, Švojgr K, Hošek P, Lukš A, Kynčl M, Eckschlager T. Is There a Higher Incidence of Sporadic Renal Angiomyolipoma in Childhood Cancer Survivors? Clin Epidemiol 2021; 13:707-716. [PMID: 34408499 PMCID: PMC8364828 DOI: 10.2147/clep.s317903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022] Open
Abstract
Background Cancer treatment can cause various long-term side effects, including those that impact ultrasound findings. During follow-up of childhood cancer survivors (CCSs), we often detected sporadic renal angiomyolipomas without histological confirmation (SAMLs), which is why we initiated this study. We compared the occurrence of SAML in CCSs to the previously reported data from a non-cancer population and correlated SAML with cancer treatment-related factors. Methods The cohort included 1098 CCSs (median age at cancer diagnosis (dg) 4.3 years) who had ultrasound follow-up (2014-2019). Of the CCSs, 525 (48%) were female, 132 (12%) had subsequent neoplasms (SNs), and 110 (10%) had genetic syndromes. CCSs were treated for lymphomas 269 (24%) and solid tumors 829 (76%). None of the CCSs had tuberous sclerosis complex (TSC). Results SAML developed in 48 (4.4%) CCSs; of these, 20 (42%) had SNs. The coincidence of SAMLs and SNs was found in CCSs with a follow-up period exceeding 20 years. The median age at SAML dg was 27.9 years (interquartile range (IQR) 22.3-34.1), and the median time to SAML dg was 22.6 years (IQR 17.4-27.6). Twenty-one (44%) CCSs developed multiple or bilateral SAMLs lesions; of these, six (12%) were in the radiotherapy field. SAML occurrence correlated with radiotherapy of the retroperitoneum (1.65-fold higher with 95% CI 0.90-3.02). The correlations with other cancer treatment factors and with female sex were less clear. Conclusion This study revealed the occurrence of SAMLs in CCSs to be 10 times higher than that in non-cancer studies. The current characteristics of CCSs with SAMLs: younger age, and more bilateral or multiple lesions are more similar to TSC associated angiomyolipoma. Moreover, we observed a coincidence of SAMLs with SNs. Our results support the hypothesis that SAML development in CCSs is not simply a late effect of therapy, and indicates other factors are involved in SAML development.
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Affiliation(s)
- Jarmila Kruseová
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Gottfriedová
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Andrea Zichová
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Karel Švojgr
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Hošek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Aleš Lukš
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Kynčl
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Tomáš Eckschlager
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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7
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van Hoefen Wijsard M, Schonfeld SJ, van Leeuwen FE, Moll AC, Fabius AW, Abramson DH, Seddon JM, Francis JH, Tucker MA, Kleinerman RA, Morton LM. Benign Tumors in Long-Term Survivors of Retinoblastoma. Cancers (Basel) 2021; 13:cancers13081773. [PMID: 33917779 PMCID: PMC8068196 DOI: 10.3390/cancers13081773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary It is well-established that hereditary retinoblastoma survivors have a substantially increased risk of developing subsequent malignant neoplasms (SMNs). Although clinicians have long suspected that this population is also at increased risk for developing benign neoplasms, the evidence is unclear. Benign tumors can substantially impact health status and quality of life, while raising questions for clinicians, when faced with a mass in a retinoblastoma survivor. By 60 years following retinoblastoma diagnosis, 17.6% of hereditary survivors had developed a benign tumor, with lipomas and leiomyomas being the most frequently diagnosed types. Additionally, we report both an increased risk of benign tumors after SMNs and a reciprocal increased risk of SMNs after benign tumors among hereditary retinoblastoma survivors. If confirmed, the large magnitude of the absolute risks and the association between benign tumors and SMNs in this population may have implications for long-term surveillance. Abstract Hereditary retinoblastoma survivors have substantially increased risk of subsequent malignant neoplasms (SMNs). The risk of benign neoplasms, a substantial cause of morbidity, is unclear. We calculated the cumulative incidence of developing benign tumors at 60 years following retinoblastoma diagnosis among 1128 hereditary (i.e., bilateral retinoblastoma or unilateral with family history, mutation testing was not available) and 924 nonhereditary retinoblastoma survivors diagnosed during 1914–2006 at two US medical centers with follow-up through 2016. Using Cox proportional hazards regression, we compared benign tumor risk by hereditary status and evaluated the association between benign tumors and SMNs. There were 100 benign tumors among 73 hereditary survivors (cumulative incidence = 17.6%; 95% confidence interval [CI] = 12.9–22.8%) and 22 benign tumors among 16 nonhereditary survivors (cumulative incidence = 3.9%; 95%CI = 2.2–6.4%), corresponding to 4.9-fold (95%CI = 2.8–8.4) increased risk for hereditary survivors. The cumulative incidence after hereditary retinoblastoma was highest for lipoma among males (14.0%; 95%CI = 7.7–22.1%) and leiomyoma among females (8.9%; 95%CI = 5.2–13.8%). Among hereditary survivors, having a prior SMN was associated with 3.5-fold (95%CI = 2.0–6.1) increased risk of developing a benign tumor; the reciprocal risk for developing an SMN after a benign tumor was 1.8 (95%CI = 1.1–2.9). These large-scale, long-term data demonstrate an increased risk for benign tumors after hereditary versus nonhereditary retinoblastoma. If confirmed, the association between benign tumors and SMNs among hereditary patients may have implications for long-term surveillance.
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Affiliation(s)
- Milo van Hoefen Wijsard
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.v.H.W.); (A.C.M.); (A.W.F.)
| | - Sara J. Schonfeld
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA; (S.J.S.); (M.A.T.); (R.A.K.)
| | - Flora E. van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Annette C. Moll
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.v.H.W.); (A.C.M.); (A.W.F.)
| | - Armida W. Fabius
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.v.H.W.); (A.C.M.); (A.W.F.)
| | - David H. Abramson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (D.H.A.); (J.H.F.)
| | - Johanna M. Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, MA 01605, USA;
| | - Jasmine H. Francis
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (D.H.A.); (J.H.F.)
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA; (S.J.S.); (M.A.T.); (R.A.K.)
| | - Ruth A. Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA; (S.J.S.); (M.A.T.); (R.A.K.)
| | - Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA; (S.J.S.); (M.A.T.); (R.A.K.)
- Correspondence: ; Tel.: +1-240-276-7377
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8
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Refining the 10-Year Prediction of Left Ventricular Systolic Dysfunction in Long-Term Survivors of Childhood Cancer. JACC: CARDIOONCOLOGY 2021; 3:62-72. [PMID: 34396306 PMCID: PMC8352242 DOI: 10.1016/j.jaccao.2020.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022]
Abstract
Background In childhood cancer survivors (CCS) at risk for heart failure, echocardiographic surveillance recommendations are currently based on anthracyclines and chest-directed radiotherapy dose. Whether the ejection fraction (EF) measured at an initial surveillance echocardiogram can refine these recommendations is unknown. Objectives The purpose of this study was to assess the added predictive value of EF at >5 years after cancer diagnosis to anthracyclines and chest-directed radiotherapy dose in CCS, for the development of left ventricular dysfunction with an ejection fraction <40% (LVD40). Methods Echocardiographic surveillance was performed in 299 CCS from the Emma Children’s Hospital in the Netherlands. Cox regression models were built including cardiotoxic cancer treatment exposures with and without EF to estimate the probability of LVD40 at 10-year follow-up. Calibration, discrimination, and reclassification were assessed. Results were externally validated in 218 CCS. Results Cumulative incidences of LVD40 at 10-year follow-up were 3.7% and 3.6% in the derivation and validation cohort, respectively. The addition of EF resulted in an integrated area under the curve increase from 0.74 to 0.87 in the derivation cohort and from 0.72 to 0.86 in the validation cohort (likelihood ratio p < 0.001). Reclassification of CCS without LVD40 improved significantly (noncase continuous net reclassification improvement 0.50; 95% confidence interval [CI]: 0.40 to 0.60). A predicted LVD40 probability ≤3%, representing 75% of the CCS, had a negative predictive value of 99% (95% CI: 98% to 100%) for LVD40 within 10 years. However, patients with midrange EF (40% to 49%) at initial screening had an incidence of LVD40 of 11% and a 7.81-fold (95% CI: 2.07- to 29.50-fold) increased risk of LV40 at follow-up. Conclusions In CCS, an initial surveillance EF, in addition to anthracyclines and chest-directed radiotherapy dose, improves the 10-year prediction for LVD40. Through this strategy, both the identification of low-risk survivors in whom the surveillance frequency may be reduced and a group of survivors at increased risk of LVD40 could be identified.
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Bal MH, Harlev A, Sergienko R, Levitas E, Har-Vardi I, Zeadna A, Mark-Reich A, Becker H, Ben-David N, Naggan L, Wainstock T. Possible association between in vitro fertilization technologies and offspring neoplasm. Fertil Steril 2021; 116:105-113. [PMID: 33597091 DOI: 10.1016/j.fertnstert.2020.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the association among fertility treatments, treatment protocol, and offspring neoplasm risk up to the age of 18 years. DESIGN A population-based retrospective cohort. SETTING Soroka University Medical Center (SUMC), the single tertiary medical center and in vitro fertilization (IVF) unit in southern Israel. PATIENT(S) All offspring born at the SUMC between the years 1995 and 2018 after IVF treatment (the exposed group) and offspring conceived spontaneously (the unexposed group). INTERVENTION(S) The study was performed at the SUMC, the single tertiary medical center and IVF unit in southern Israel. The exposed and unexposed were matched with a ratio of 1:4, based on maternal age and calendar month of delivery. Data collection included a summary of the couple's medical records, delivery data, and offspring neoplasm diagnoses. MAIN OUTCOME MEASURE(S) Offspring neoplasm of any kind and time to diagnosis in each of the groups. RESULT(S) A total of 1,583 exposed and 5,874 offspring were included in the study. The incidences of offspring benign neoplasm were 14 (0.9%) versus 21 (0.4%), and the incidences of malignancies were 17 (1.1%) versus 29 (0.5%) among offspring of the IVF and spontaneous groups, respectively. The association between mode of conception and offspring neoplasm risk remained significant after adjusting for confounders, including mode of delivery and pregnancy complications such as hypertensive disorder, gestational diabetes mellitus, and preterm delivery compared with spontaneously conceived offspring. Among the IVF group, the increased risk for neoplasm was found among offspring who were transferred as fresh embryos, at an earlier stage of development (cleavage stage), or after three or more aspirated oocytes. CONCLUSION(S) IVF treatment is associated with offspring neoplasm risk; specifically, the risk was greater among offspring who were returned as fresh embryos, at an earlier embryotic stage (cleavage stage), or after three or more aspirated oocytes.
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Affiliation(s)
- Maayan Hagbi Bal
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Avi Harlev
- In Vitro Fertilization Unit, Barzilai University Medical Center, Ashkelon, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eliahu Levitas
- Fertility and IVF Unit, Department of Obstetrics/Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Har-Vardi
- Fertility and IVF Unit, Department of Obstetrics/Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Atif Zeadna
- Fertility and IVF Unit, Department of Obstetrics/Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Mark-Reich
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadas Becker
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noa Ben-David
- Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lechaim Naggan
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Deng W, Wang Y, Liu X, Liu J, Wang L, Yang Z, Yang M, An Y, Tang C, Sanford NN, Kim BYS, Jiang W. Assessment of Trends in Second Primary Cancers in Patients With Metastatic Melanoma From 2005 to 2016. JAMA Netw Open 2020; 3:e2028627. [PMID: 33295975 PMCID: PMC7726633 DOI: 10.1001/jamanetworkopen.2020.28627] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE To date, the risk of developing second primary cancers (SPCs) after the first primary melanoma has not been studied in the era of immune checkpoint inhibitors (ICIs). OBJECTIVE To assess differences in the risk of SPCs in patients with primary melanoma before (2005-2010) and after (2011-2016) the introduction and approval of ICIs. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study using the Surveillance, Epidemiology, and End Results database from January 2005 to December 2016 of patients diagnosed with metastatic melanoma. Data were analyzed from January 4 to June 30, 2020. EXPOSURES Receipt of immunotherapy or other anticancer agents. MAIN OUTCOMES AND MEASURES The primary outcome was the development of second primary cancers in patients with melanoma. Standardized incidence ratios (SIRs) were calculated for the development of SPCs before and after the introduction of ICIs. RESULTS Among 5016 patients with diagnosed metastatic melanoma, 2888 (58%) were younger than 65 years at the time of diagnosis, and 3441 (69%) were male. From 2005 to 2010, SIRs were 3.24 (95% CI, 0.08-18.04) for small intestine cancer, 1.93 (95% CI, 1.14-3.05) for lung and bronchus cancer, 2.77 (95% CI, 1.02-6.03) for kidney cancer, and 7.29 (95% CI, 2.93-15.02) for myeloma. From 2011 to 2016, SIRs were 9.23 (95% CI, 1.12-33.35) for small intestine cancer, 1.54 (95% CI, 0.71-2.93) for lung and bronchus cancer, 2.66 (95% CI, 0.73-6.82) for kidney cancer, and 5.90 (95% CI, 1.61-15.10) for myeloma. The overall risk of developing SPCs in individuals who survived the first primary melanoma was 65% higher (SIR, 1.65; 95% CI, 1.35-2.00) in the pre-ICIs period and 98% higher (SIR, 1.98; 95% CI, 1.57-2.45) in the post-ICIs period than the overall cancer incidence rate in the general population. CONCLUSIONS AND RELEVANCE In this study, an increase in the overall risk of second primary cancers after melanoma after the introduction of immune checkpoint inhibitors was observed. The pattern of SPCs has been altered in the era of systemic therapy. Close monitoring and screening for SPCs may be warranted in patients with metastatic melanoma.
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Affiliation(s)
- Weiye Deng
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Yifan Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Xiangyu Liu
- Department of Biostatistics and Data Science, School of Public Health, the University of Texas Health Science Center, Houston
| | - Jieqiong Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Wang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Zhaogang Yang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Mingming Yang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Chad Tang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Betty Y. S. Kim
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston
| | - Wen Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
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