Secondary cancers after a childhood cancer diagnosis: a nationwide hospital-based retrospective cohort study in Japan

Yasushi Ishida, Dongmei Qiu, Miho Maeda, Junichiro Fujimoto, Hisato Kigasawa, Ryoji Kobayashi, Maho Sato, Jun Okamura, Shinji Yoshinaga, Takeshi Rikiishi, Hiroyuki Shichino, Chikako Kiyotani, Kazuko Kudo, Keiko Asami, Hiroki Hori, Hiroshi Kawaguchi, Hiroko Inada, Souichi Adachi, Atsushi Manabe, Tatsuo Kuroda

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)506-516
Number of pages11
JournalInternational Journal of Clinical Oncology
Issue number3
Publication statusPublished - 2016 Jun 1


  • Childhood cancer
  • Cumulative incidence
  • Risk factors
  • Secondary cancers
  • Standardized incidence ratio

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology


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