Risk of rare adult-type carcinomas as a subsequent malignant neoplasm in survivors of childhood cancer: The Childhood Cancer Survivor Study
Bibliographic record
Abstract
8530 Background: Subsequent malignant neoplasms (SMNs) are a leading cause of late mortality in survivors of childhood cancer. Using the Childhood Cancer Survivor Study (CCSS) cohort, we determined the risk of carcinomas occurring as SMNs excepting breast, thyroid and skin cancers. Methods: A retrospective cohort of 14,352 five-year survivors of childhood cancers treated at 25 US and Canadian institutions was assembled. SMNs were ascertained through self-administered questionnaires and confirmed with pathology reports. Cumulative incidence, age- and gender-matched standardized incidence ratios (SIRs) were calculated. Results: In 71 individuals, 71 carcinomas of interest were found at a median age of 27 years (range 10–44 years) and a median elapsed time of 15 years (range 6–28 years) from first malignancy. Twenty-five (35%) SMNs occurred in the genitourinary system, 23 (32%) in the head and neck area, 16 (23%) in the digestive tract, 4 (6%) in the thorax and the remainder (4%) in other sites. Fifty-nine subjects (83%) had received radiation therapy, 49 (69%) had a history of alkylator therapy, and 8 (11%) had a history of epipodophyllotoxin therapy. Forty-two carcinomas (59%) arose in a radiation field. An excess of carcinomas was found following all childhood diagnoses, and was highest for neuroblastoma (SIR = 24.2 [95% confidence interval [CI] = 12.6–46.5]), soft tissue sarcomas (SIR = 6.2, [95% CI = 3.5–11]) and Wilms tumor (SIR = 4.8 [95% CI = 1.5–14.8]). There was a significant excess of carcinomas in most of the morphology types examined and was greatest for mucoepidermoid neoplasms (SIR=34.0 [95%CI= 19.3–59.9]) and renal cell carcinomas (SIR = 13.3 [95%CI = 6.7–26.7]). The 20-year cumulative incidence for all SMNs in this report is 0.45%. Conclusions: Childhood cancer survivors are at increased risk of developing subsequent adult-type carcinomas, but the cumulative incidence is low. Further analyses of the contribution of patient and treatment factors to the increased risk of carcinomas in this population are in progress. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".