Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study
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Publication date
2018-07-01
Authors
Teepen, J C
Kok, Judith L
van Leeuwen, Flora E
Tissing, Wim J E
Dolsma, Wil V
van der Pal, Helena J
Loonen, Jacqueline J
Bresters, Dorine
Versluijs, Anne Birgitta
van den Heuvel-Eibrink, Marry M
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Article
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taverne
Abstract
Background: Although colorectal adenomas serve as prime target for colorectal cancer (CRC) surveillance in other high-risk groups, data on adenoma risk after childhood cancer are lacking. We evaluated the risk of histologically confirmed colorectal adenomas among childhood cancer survivors. A secondary aim was to assess CRC risk. Methods: The DCOG-LATER cohort study includes five-year Dutch childhood cancer survivors and a sibling comparison group (n = 883). Colorectal tumors were identified from the population-based Dutch Pathology Registry (PALGA). We calculated cumulative incidences of adenomas/CRCs for survivors and siblings. For adenomas, multivariable Cox regression models were used to evaluate potential risk factors. All statistical tests were two-sided. Results: Among 5843 five-year survivors (median follow-up = 24.9 years), 78 individuals developed an adenoma. Cumulative incidence by age 45 years was 3.6% (95% confidence interval [CI] = 2.2% to 5.6%) after abdominopelvic radiotherapy (AP-RT; 49 cases) vs 2.0% (95% CI = 1.3% to 2.8%) among survivors without AP-RT (28 cases; Pdifference = .07) and vs 1.0% (95% CI = 0.3% to 2.6%) among siblings (6 cases) (Pdifference = .03). Factors associated with adenoma risk were AP-RT (hazard ratio [HR] = 2.12, 95% CI = 1.24 to 3.60), total body irradiation (TBI; HR = 10.55, 95% CI = 5.20 to 21.42), cisplatin (HR = 2.13; 95% CI = 0.74 to 6.07 for <480 mg/m²; HR = 3.85, 95% CI = 1.45 to 10.26 for ≥480 mg/m²; Ptrend = .62), a hepatoblastoma diagnosis (HR = 27.12, 95% CI = 8.80 to 83.58), and family history of early-onset CRC (HR = 20.46, 95% CI = 8.10 to 51.70). Procarbazine was statistically significantly associated among survivors without AP-RT/TBI (HR = 2.71, 95% CI = 1.28 to 5.74). Thirteen CRCs occurred. Conclusion: We provide evidence for excess risk of colorectal adenomas and CRCs among childhood cancer survivors. Adenoma risk factors include AP-RT, TBI, cisplatin, and procarbazine. Hepatoblastoma (familial adenomatous polyposis-associated) and family history of early-onset CRC were confirmed as strong risk factors. A full benefit-vs-harm evaluation of CRC screening among high-risk childhood cancer survivors warrants consideration.
Keywords
Adenoma/epidemiology, Adolescent, Adult, Age of Onset, Cancer Survivors/statistics & numerical data, Child, Child, Preschool, Colorectal Neoplasms/epidemiology, Female, Follow-Up Studies, Humans, Male, Medical Record Linkage/methods, Middle Aged, Neoplasms, Second Primary/epidemiology, Netherlands/epidemiology, Registries, Young Adult, Taverne, Oncology, Cancer Research, Research Support, Non-U.S. Gov't, Journal Article
Citation
Teepen, J C, Kok, J L, van Leeuwen, F E, Tissing, W J E, Dolsma, W V, van der Pal, H J, Loonen, J J, Bresters, D, Versluys, A B, van den Heuvel-Eibrink, M M, van Dulmen-den Broeder, E, van den Berg, M H, van der Heiden-van der Loo, M, Hauptmann, M, Jongmans, M C, Overbeek, L I, van de Vijver, M J, Kremer, L C M, Ronckers, C M, Aleman, B M P, van den Berg, M H, Caron, H N, Daniels, L A, Dolsma, W, van Dulmen-den Broeder, E, Grootenhuis, M A, Haasbeek, C J, den Hartogh, J G, Hauptmann, M, van der Heiden-van der Loo, M, van den Heuvel-Eibrink, M M, Hollema, N, Janssens, G O, Jongmans, M C, Jaspers, M W M, Kok, J L, van Leeuwen, F E, Loonen, J, Maduro, J H, Neggers, S J C M M, Oldenburger, F, van der Pal, H J, Postma, A, Ronckers, C M, Tersteeg, R J, Tissing, W J E, Versluys, A B, Zsíros, J & DCOG-LATER Study Group 2018, 'Colorectal Adenomas and Cancers After Childhood Cancer Treatment : A DCOG-LATER Record Linkage Study', Journal of the National Cancer Institute, vol. 110, no. 7, pp. 758-767. https://doi.org/10.1093/jnci/djx266