TY - JOUR
T1 - Twenty-five year follow-up of childhood Wilms tumor
T2 - A report from the Childhood Cancer Survivor Study
AU - Termuhlen, Amanda M.
AU - Tersak, Jean M.
AU - Liu, Qi
AU - Yasui, Yutaka
AU - Stovall, Marilyn
AU - Weathers, Rita
AU - Deutsch, Melvin
AU - Sklar, Charles A.
AU - Oeffinger, Kevin C.
AU - Armstrong, Greg
AU - Robison, Leslie L.
AU - Green, Daniel M.
PY - 2011/12/15
Y1 - 2011/12/15
N2 - Background: Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS). Procedure: The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N=1,256), diagnosed 1970-1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N=4,023). Results: The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8-2.3 for grades 1-4 and 4.7, 95%CI 3.6-6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2-2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9-4.0%) and of mortality was 6.1% (95%CI 4.7-7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin-HR 6.6; 95%CI 1.6-28.3; doxorubicin ≤250mg/m 2-HR 13.0; 95%CI 1.9-89.7; doxorubicin >250mg/m 2-HR 18.3; 95%CI 3.8-88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9-17.7 with and 4.9; 95%CI 1.8-10.6 without doxorubicin) and death. Conclusion: Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis.
AB - Background: Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS). Procedure: The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N=1,256), diagnosed 1970-1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N=4,023). Results: The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8-2.3 for grades 1-4 and 4.7, 95%CI 3.6-6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2-2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9-4.0%) and of mortality was 6.1% (95%CI 4.7-7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin-HR 6.6; 95%CI 1.6-28.3; doxorubicin ≤250mg/m 2-HR 13.0; 95%CI 1.9-89.7; doxorubicin >250mg/m 2-HR 18.3; 95%CI 3.8-88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9-17.7 with and 4.9; 95%CI 1.8-10.6 without doxorubicin) and death. Conclusion: Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis.
KW - Late effects
KW - Survivorship
KW - Wilms tumor
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U2 - 10.1002/pbc.23090
DO - 10.1002/pbc.23090
M3 - Article
C2 - 21384541
AN - SCOPUS:80053903886
SN - 1545-5009
VL - 57
SP - 1210
EP - 1216
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 7
ER -