Subsequent malignant neoplasms (SMNs) among non-irradiated survivors of childhood cancer treated with chemotherapy in the Childhood Cancer Survivor Study.
Bibliographic record
Abstract
10509 Background: In recent treatment eras radiotherapy (RT) use decreased while chemotherapy (CT) increased. RT is an established risk factor for SMNs. Limited data exist on how CT increases risk for SMNs > 5 years after childhood cancer. Methods: SMNs were evaluated in 5-year survivors diagnosed < 21 years of age between 1970-99, treated with CT and not RT (N = 7447, 138,008 person-years follow-up). 30-year cumulative incidence and 95% confidence intervals (CI) and standardized incidence ratios (SIRs) for SMNs were estimated. SIRs were estimated for chemotherapy exposures [alkylator: 0, 1-3999, 4000-7999, ≥8000 mg/m2; platinum: 0, 1-400, 401-750, > 750 mg/m2; anthracycline: 0, 1-100, 101-300, > 300 mg/m2; epipodophyllotoxin: 0, 1-1000, 1001-4000, > 4000 mg/m2]. Results: There were 154 SMNs among 139 survivors. Cumulative incidence for SMNs at 30 years was 4.5% (95% CI 3.4-5.6) and risk for SMN was 3-fold greater than the general population. Survivors of leukemia, lymphoma, and sarcomas had increased risk for SMNs (Table), whereas, survivors of Wilms tumor, neuroblastoma and CNS cancer did not. Exposure to moderate- to high-dose alkylator (≥4000 mg/m2) or platinum ( > 400 mg/m2) or high-dose anthracycline ( > 300 mg/m2) or epiodophyllotoxin ( > 4000 mg/m2) therapy had SIRs of ≥4.0. A combination of alkylators and platinum, one of the two being high-dose and the other being moderate or high-dose, had a SIR of 13.0 (95% CI 6.5-23.2). Conclusions: Non-RT exposed survivors are at increased risk for SMN and should be counseled regarding the potential for genetic predisposition and the need for increased surveillance for early detection of subsequent cancers. SIRs (95% CI) for SMNs by childhood cancer diagnosis. Primary Cancer SMN All SMNs (n = 154) Leukemia/ Lymphoma (n = 21) Breast (n = 34) Soft tissue sarcoma (n = 14) Thyroid (n = 20) Melanoma (n = 15) All diagnoses 3.1 (2.6-3.6) 2.9 (2.4-3.4) 6.3 (4.4-8.9) 4.1 (2.2-6.8) 3.5 (2.2-5.5) 3.4 (2.1-5.3) Leukemia/lymphoma (n = 4309) 2.7 (2.2-3.4) 2.1 (1.2-3.4) 6.3 (3.7-10.1) 1.5 (0.3-4.3) 2.6 (1.2-5.0) 4.1 (2.3-6.9) Sarcoma (n = 1484) 3.8 (3.0-4.9) 2.5 (1.0-5.1) 7.1 (4.1-11.3) 10.0 (4.8-18.4) 5.6 (2.6-10.7) 3.2 (1.2-7.0)
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| 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".