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.

中文翻译：

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儿童癌症治疗后的大肠腺瘤和癌症：DCOG-LATER记录连锁研究。

背景技术尽管在其他高风险人群中，结直肠腺瘤是进行结直肠癌（CRC）监测的主要目标，但仍缺乏有关儿童期癌症后腺瘤风险的数据。我们评估了儿童癌症幸存者中经组织学证实的结直肠腺瘤的风险。次要目的是评估CRC风险。方法DCOG-LATER队列研究包括荷兰五年期儿童癌症幸存者和同胞比较组（n = 883）。大肠肿瘤是从以人群为基础的荷兰病理注册处（PALGA）中鉴定的。我们计算了幸存者和兄弟姐妹的腺瘤/ CRC累积发病率。对于腺瘤，使用多变量Cox回归模型评估潜在的危险因素。所有统计检验都是两面的。结果在5843名五年幸存者中（中位随访时间= 24.9年），78名个体出现了腺瘤。腹部骨盆放疗（AP-RT； 49例）后，45岁年龄段的累积发生率为3.6％（95％置信区间[CI] = 2.2％至5.6％），而2.0％（95％CI = 1.3％至2.8％）没有AP-RT的幸存者（28例； Pdifference = .07）和兄弟姐妹（6例）中的1.0％（95％CI = 0.3％至2.6％）（Pdifference = .03）。与腺瘤风险相关的因素包括AP-RT（危险比[HR] = 2.12，95％CI = 1.24至3.60），全身照射（TBI； HR = 10.55，95％CI = 5.20至21.42），顺铂（HR = 2.13；对于<480 mg /m²，95％CI = 0.74至6.07； HR = 3.85，对于≥480mg /m²，95％CI = 1.45至10.26； Ptrend = .62），诊断为成肝细胞瘤（HR = 27.12，95％ CI = 8.80至83.58），以及早发CRC的家族史（HR = 20.46，95％CI = 8.10至51.70）。在无AP-RT / TBI的幸存者中，丙卡巴嗪在统计学上显着相关（HR = 2.71，95％CI = 1.28至5.74）。发生了13个CRC。结论我们为儿童癌症幸存者中结直肠腺瘤和CRC的额外风险提供了证据。腺瘤的危险因素包括AP-RT，TBI，顺铂和卡巴嗪。肝母细胞瘤（家族性腺瘤性息肉病相关）和早发性CRC的家族史被确认为强烈的危险因素。在高危儿童期癌症幸存者中进行CRC筛查的全面利弊评估值得考虑。肝母细胞瘤（家族性腺瘤性息肉病相关）和早发性CRC的家族史被确认为强烈的危险因素。在高危儿童期癌症幸存者中进行CRC筛查的全面利弊评估值得考虑。肝母细胞瘤（家族性腺瘤性息肉病相关）和早发性CRC的家族史被确认为强烈的危险因素。在高危儿童期癌症幸存者中进行CRC筛查的全面利弊评估值得考虑。