Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study.

CANCER EPIDEMIOLOGY COLORECTAL CANCER COLORECTAL CANCER SCREENING GASTROINTESTINAL CANCER

Journal

Gut
ISSN: 1468-3288
Titre abrégé: Gut
Pays: England
ID NLM: 2985108R

Informations de publication

Date de publication:
02 Nov 2020
Historique:
received: 18 06 2020
revised: 11 09 2020
accepted: 28 09 2020
entrez: 3 11 2020
pubmed: 4 11 2020
medline: 4 11 2020
Statut: aheadofprint

Résumé

Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide. The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence. 427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected. Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.

Sections du résumé

BACKGROUND BACKGROUND
Survivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide.
METHODS METHODS
The PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence.
RESULTS RESULTS
427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN-comparable to the risk among members of the general population with at least two first-degree relatives affected.
CONCLUSIONS CONCLUSIONS
Colonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.

Identifiants

DOI: 10.1136/gutjnl-2020-322237 PMID: 33139271
pubmed: 33139271
pii: gutjnl-2020-322237
doi: 10.1136/gutjnl-2020-322237
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: HL and TW are shareholders in, and have signed an intellectual property agreement with the company Concidera Health. The company develops clinical decision support tools for childhood cancer survivorship.

Auteurs

Raoul C Reulen (RC)

Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK.
ORCID: 0000-0002-7328-0467

Kwok F Wong (KF)

National Cancer Registration and Analysis Service, Public Health England, London, UK.

Chloe J Bright (CJ)

National Cancer Registration and Analysis Service, Public Health England, London, UK.

David L Winter (DL)

Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK.

Daniela Alessi (D)

Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy.

Rodrigue M Allodji (RM)

Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France.
ORCID: 0000-0002-1895-8415

Francesca Bagnasco (F)

Epidemiology and Biostatistics Unit, Instituto Giannina Gaslini, Genova, Italy.

Edit Bárdi (E)

2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Kepler Universitätsklinikum, Linz, Austria.

Andrea Bautz (A)

Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.

Julianne Byrne (J)

Boyne Research Institute, Drogheda, Ireland.

Elizabeth Am Feijen (EA)

Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.

Miranda M Fidler-Benaoudia (MM)

Epidemiology and Prevention Research, Departments of Oncology and Community Health Sciences, Calgary, Alberta, Canada.

Ibrahim Diallo (I)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Stanislaw Garwicz (S)

Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.

Desiree Grabow (D)

German Childhood Cancer Registry, University Medical Centre Mainz, Mainz, Germany.

Thorgerdur Gudmundsdottir (T)

Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland.

Joyeeta Guha (J)

Public Health England and NHS England & Improvement, Birmingham, UK.

Nadia Haddy (N)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Stine Høgsholt (S)

Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.

Moncilo Jankovic (M)

Pediatric Clinic, University of Milan-Bicocca, Hospital San Gerardo, Monza, Lombardia, Italy.

Peter Kaatsch (P)

German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.

Melanie Kaiser (M)

German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.

Rahel Kuonen (R)

Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.

Helena Linge (H)

Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.

Hilde Øfstaas (H)

Norwegian National Advisory Unit on solid tumors in children, Oslo, Norway.

Cecile M Ronckers (CM)

Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands.

Eva-Maria Hau (EM)

Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.
Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland.

Roderick Skinner (R)

Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Newcastle University Centre for Cancer, Newcastle Upon Tyne, UK.

Flora E van Leeuwen (FE)

Department of Epidemiology, Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Jop C Teepen (JC)

Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.

Cristina Veres (C)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Wael Zrafi (W)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Ghazi Debiche (G)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Damien Llanas (D)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Monica Terenziani (M)

Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy.

Giao Vu-Bezin (G)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Finn Wesenberg (F)

Norwegian Cancer Registry and Dept. of Pediatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, Faculty of medicine, University of Oslo, Oslo, Norway.

Thomas Wiebe (T)

Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.

Carlotta Sacerdote (C)

Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and AOU Città della Salute e della Scienza di Torino, Italy, Childhood cancer registry of piedmont, Turin, Italy.

Zsuzsanna Jakab (Z)

Hungarian Childhood Cancer Registry, Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary.

Riccardo Haupt (R)

Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.

Päivi M Lähteenmäki (PM)

Department of Pediatrics and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland.

Lorna Zadravec Zaletel (L)

Division of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.

Claudia E Kuehni (CE)

Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland.
Department of Paediatrics, University Children's Hospital of Bern, University of Bern, Bern, BE, Switzerland.

Jeanette F Winther (JF)

Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark.

Florent de Vathaire (F)

Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France, Villejuif, France.

Leontien C Kremer (LC)

Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Department of pediatric Oncology, Emma Children's Hospital & Academic Medical Center, Amsterdam, The Netherlands.

Lars Hjorth (L)

Department of Clinical Sciences, Skåne University Hospital, Lund University, Pediatrics, Lund, Skåne, Sweden.

Michael M Hawkins (MM)

Centre for Childhood Cancer Survivor Studies, University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK m.m.hawkins@bham.ac.uk.

Classifications MeSH