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This version published online on July 5, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-0656
A more recent version of this article appeared on September 1, 2006
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Submitted on March 24, 2006
Accepted on June 23, 2006

Growth Hormone Treatment and Risk of Second Neoplasms in the Childhood Cancer Survivor

Berrin Ergun-Longmire, Ann C Mertens, Pauline Mitby, Jing Qin, Glenn Heller, Weiji Shi, Yutaka Yasui, Leslie L Robison, and Charles A Sklar*

Department of Pediatrics, New York Presbyterian Hospital, Weill Medical College of Cornell, New York, NY, United States, 10021; Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States, 55455; Departments of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 10021; Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 10021

* To whom correspondence should be addressed. E-mail: sklarc{at}mskcc.org.

Context: Growth hormone (GH) deficiency is common in childhood cancer survivors. In a previous report, while we did not find an increase in the risk of disease recurrence in survivors treated with GH, GH-treated survivors did have an increased risk of developing a second neoplasm (SN) (rate ratio [RR] 3.21).

Objective: In this analysis, we have re-assessed the risk of GH-treated survivors developing a SN after an additional 32 months of follow up.

Design: Retrospective cohort study.

Setting: Multicenter study.

Patients: Among a total of 14,108 survivors who were enrolled in the Childhood Cancer Survivor Study, a retrospective cohort of 5-yr-survivors of childhood cancer, we identified 361 who were treated with GH.

Main outcome: Risk of developing a SN.

Results: During the extended follow-up, 5 new SN developed in survivors treated with GH, for a total of 20 SN, all solid tumors. Using a time-dependent Cox model, the RR of GH-treated survivors developing an SN, compared with non GH-treated survivors, was 2.15 (95% CI, 1.3-3.5, P < 0.002). Meningiomas were the most common SN (n = 9) among the GH-treated group.

Conclusion: Although cancer survivors treated with GH appear to have an increased risk of developing SN compared with survivors not so treated, the elevation of risk due to GH use appears to diminish with increasing length of follow up. Continued surveillance is essential.
Key words: Growth hormone • childhood cancer survivors • second neoplasm




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