@article{oai:repo.qst.go.jp:00047550,
 author = {Ishida, Yasushi and Qiu, Dongmei and Maeda, Miho and Fujimoto, Junichiro and Kigasawa, Hisato and Kobayashi, Ryoji and Sato, Maho and Okamura, Jun and Yoshinaga, Shinji and Rikiishi, Takeshi and Shichino, Hiroyuki and Kiyotani, Chikako and Kudo, Kazuko and Asami, Keiko and Hori, Hiroki and Kawaguchi, Hiroshi and Inada, Hiroko and Adachi, Souichi and Manabe, Atsushi and Kuroda, Tatsuo and 吉永 信治},
 issue = {3},
 journal = {International Journal of Clinical Oncology},
 month = {Nov},
 note = {Background
The epidemiology of secondary cancers in childhood cancer survivors has been unknown in Asian countries. Our aim is to assess the incidence and risk factors for secondary cancers through a nationwide survey in Japan.
\nMethods
A retrospective cohort study comprising 10,069 children who were diagnosed with cancer between 1980 and 2009 was conducted in 15 Japanese hospitals. The cumulative incidence rate was calculated using death as the competing risk and compared by the Gray method. The standardized incidence ratio (SIR) was defined as the ratio of the number of observed cancers divided by the number of expected cancers. The risk factors were analyzed using Cox regression analysis.
\nResults
One hundred and twenty-eight patients (1.3 %) developed secondary cancers within a median follow-up of 8.4 years. The cumulative incidence rate was 1.1 % (95 % confidence interval [CI] 0.9–1.4) at 10 years and 2.6 % (95 % CI 2.1–3.3) at 20 years after primary cancer diagnosis. Sensitivity analysis, limited to 5-year survivors (n = 5,387), confirmed these low incidence rates. The SIR of secondary cancers was 12.1 (95 % CI 10.1–14.4). In the Cox analysis, the hazard ratios for secondary cancers were 3.81 (95 % CI 1.53–9.47) for retinoblastoma, 2.78 (95 % CI 1.44–5.38) for bone/soft tissue sarcomas, and 1.81 (95 % CI 1.16–2.83) for allogeneic stem cell transplantation.
\nConclusions
The cumulative incidence of secondary cancers in children in Japan was not high; however, the SIR was relatively high. Retinoblastoma or sarcoma in addition to allogeneic stem cell transplantation were significant risk factors for secondary cancers.},
 pages = {506--516},
 title = {Secondary cancers after a childhood cancer diagnosis: a nationwide hospital-based retrospective cohort study in Japan},
 volume = {21},
 year = {2015}
}