Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study

J C Teepen; Judith L Kok; Flora E van Leeuwen; Wim J E Tissing; Wil V Dolsma; Helena J van der Pal; Jacqueline J Loonen; Dorine Bresters; A B Versluys; Marry M van den Heuvel-Eibrink; Eline van Dulmen-den Broeder; Marleen H van den Berg; Margriet van der Heiden-van der Loo; Michael Hauptmann; M C Jongmans; L I Overbeek; M J van de Vijver; L C M Kremer; C M Ronckers; B M P Aleman; M H van den Berg; H N Caron; L A Daniels; W Dolsma; E van Dulmen-den Broeder; M A Grootenhuis; C J Haasbeek; J G den Hartogh; M Hauptmann; M van der Heiden-van der Loo; Marry M van den Heuvel-Eibrink; N Hollema; G O Janssens; M C Jongmans; M W M Jaspers; J L Kok; F E van Leeuwen; J Loonen; J H Maduro; S J C M M Neggers; F Oldenburger; H J van der Pal; A Postma; C M Ronckers; R J Tersteeg; Wim J E Tissing; A B Versluys; J Zsíros

doi:10.1093/jnci/djx266

Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study

J C Teepen, Judith L Kok, Flora E van Leeuwen, Wim J E Tissing, Wil V Dolsma, Helena J van der Pal, Jacqueline J Loonen, Dorine Bresters, A B Versluys, Marry M van den Heuvel-Eibrink, Eline van Dulmen-den Broeder, Marleen H van den Berg, Margriet van der Heiden-van der Loo, Michael Hauptmann, M C Jongmans, L I Overbeek, M J van de Vijver, L C M Kremer, C M Ronckers, B M P AlemanM H van den Berg, H N Caron, L A Daniels, W Dolsma, E van Dulmen-den Broeder, M A Grootenhuis, C J Haasbeek, J G den Hartogh, M Hauptmann, M van der Heiden-van der Loo, Marry M van den Heuvel-Eibrink, N Hollema, G O Janssens, M C Jongmans, M W M Jaspers, J L Kok, F E van Leeuwen, J Loonen, J H Maduro, S J C M M Neggers, F Oldenburger, H J van der Pal, A Postma, C M Ronckers, R J Tersteeg, Wim J E Tissing, A B Versluys, J Zsíros,

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	758-767
Number of pages	10
Journal	Journal of the National Cancer Institute
Volume	110
Issue number	7
DOIs	https://doi.org/10.1093/jnci/djx266
Publication status	Published - 1 Jul 2018

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

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10.1093/jnci/djx266

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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. (2018). Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study. Journal of the National Cancer Institute, 110(7), 758-767. https://doi.org/10.1093/jnci/djx266

@article{8161c6d02ee24d268adce5a8bc7b3a14,

title = "Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study",

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",

author = "Teepen, {J C} and Kok, {Judith L} and {van Leeuwen}, {Flora E} and Tissing, {Wim J E} and Dolsma, {Wil V} and {van der Pal}, {Helena J} and Loonen, {Jacqueline J} and Dorine Bresters and Versluys, {A B} and {van den Heuvel-Eibrink}, {Marry M} and {van Dulmen-den Broeder}, Eline and {van den Berg}, {Marleen H} and {van der Heiden-van der Loo}, Margriet and Michael Hauptmann and Jongmans, {M C} and Overbeek, {L I} and {van de Vijver}, {M J} and Kremer, {L C M} and Ronckers, {C M} and Aleman, {B M P} and {van den Berg}, {M H} and Caron, {H N} and Daniels, {L A} and W Dolsma and {van Dulmen-den Broeder}, E and Grootenhuis, {M A} and Haasbeek, {C J} and {den Hartogh}, {J G} and M Hauptmann and {van der Heiden-van der Loo}, M and {van den Heuvel-Eibrink}, {Marry M} and N Hollema and Janssens, {G O} and Jongmans, {M C} and Jaspers, {M W M} and Kok, {J L} and {van Leeuwen}, {F E} and J Loonen and Maduro, {J H} and Neggers, {S J C M M} and F Oldenburger and {van der Pal}, {H J} and A Postma and Ronckers, {C M} and Tersteeg, {R J} and Tissing, {Wim J E} and Versluys, {A B} and J Zs{\'i}ros",

note = "Funding Information: This work was supported by the Dutch Cancer Society (grant numbers DCOG2011-5027 and UVA2012-5517). Judith Kok was appointed on a Flexible Onderzoeker in Opleiding (OiO) grant awarded by the Academic Medical Center (AMC) Executive Board to C. M. Ronckers/L. C. Kremer in 2012. Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2018",

month = jul,

day = "1",

doi = "10.1093/jnci/djx266",

language = "English",

volume = "110",

pages = "758--767",

journal = "Journal of the National Cancer Institute",

issn = "0027-8874",

publisher = "Oxford University Press",

number = "7",

}

Teepen, JC, Kok, JL, van Leeuwen, FE, Tissing, WJE, Dolsma, WV, van der Pal, HJ, Loonen, JJ, Bresters, D, Versluys, AB, van den Heuvel-Eibrink, MM, van Dulmen-den Broeder, E, van den Berg, MH, van der Heiden-van der Loo, M, Hauptmann, M, Jongmans, MC, Overbeek, LI, van de Vijver, MJ, Kremer, LCM, Ronckers, CM, Aleman, BMP, van den Berg, MH, Caron, HN, Daniels, LA, Dolsma, W, van Dulmen-den Broeder, E, Grootenhuis, MA, Haasbeek, CJ, den Hartogh, JG, Hauptmann, M, van der Heiden-van der Loo, M, van den Heuvel-Eibrink, MM, Hollema, N, Janssens, GO , Jongmans, MC, Jaspers, MWM, Kok, JL, van Leeuwen, FE, Loonen, J, Maduro, JH, Neggers, SJCMM, Oldenburger, F, van der Pal, HJ, Postma, A, Ronckers, CM, Tersteeg, RJ, Tissing, WJE, Versluys, AB, Zsíros, J 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

TY - JOUR

T1 - Colorectal Adenomas and Cancers After Childhood Cancer Treatment

T2 - A DCOG-LATER Record Linkage Study

AU - Teepen, J C

AU - Kok, Judith L

AU - van Leeuwen, Flora E

AU - Tissing, Wim J E

AU - Dolsma, Wil V

AU - van der Pal, Helena J

AU - Loonen, Jacqueline J

AU - Bresters, Dorine

AU - Versluys, A B

AU - van den Heuvel-Eibrink, Marry M

AU - van Dulmen-den Broeder, Eline

AU - van den Berg, Marleen H

AU - van der Heiden-van der Loo, Margriet

AU - Hauptmann, Michael

AU - Jongmans, M C

AU - Overbeek, L I

AU - van de Vijver, M J

AU - Kremer, L C M

AU - Ronckers, C M

AU - Aleman, B M P

AU - van den Berg, M H

AU - Caron, H N

AU - Daniels, L A

AU - Dolsma, W

AU - van Dulmen-den Broeder, E

AU - Grootenhuis, M A

AU - Haasbeek, C J

AU - den Hartogh, J G

AU - Hauptmann, M

AU - van der Heiden-van der Loo, M

AU - van den Heuvel-Eibrink, Marry M

AU - Hollema, N

AU - Janssens, G O

AU - Jongmans, M C

AU - Jaspers, M W M

AU - Kok, J L

AU - van Leeuwen, F E

AU - Loonen, J

AU - Maduro, J H

AU - Neggers, S J C M M

AU - Oldenburger, F

AU - van der Pal, H J

AU - Postma, A

AU - Ronckers, C M

AU - Tersteeg, R J

AU - Tissing, Wim J E

AU - Versluys, A B

AU - Zsíros, J

N1 - Funding Information: This work was supported by the Dutch Cancer Society (grant numbers DCOG2011-5027 and UVA2012-5517). Judith Kok was appointed on a Flexible Onderzoeker in Opleiding (OiO) grant awarded by the Academic Medical Center (AMC) Executive Board to C. M. Ronckers/L. C. Kremer in 2012. Publisher Copyright: © The Author(s) 2018. Published by Oxford University Press. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Adenoma/epidemiology

KW - Adolescent

KW - Adult

KW - Age of Onset

KW - Cancer Survivors/statistics & numerical data

KW - Child

KW - Child, Preschool

KW - Colorectal Neoplasms/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Medical Record Linkage/methods

KW - Middle Aged

KW - Neoplasms, Second Primary/epidemiology

KW - Netherlands/epidemiology

KW - Registries

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85055002414&partnerID=8YFLogxK

U2 - 10.1093/jnci/djx266

DO - 10.1093/jnci/djx266

M3 - Article

C2 - 29986097

SN - 0027-8874

VL - 110

SP - 758

EP - 767

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

IS - 7

ER -

Colorectal Adenomas and Cancers After Childhood Cancer Treatment: A DCOG-LATER Record Linkage Study

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