Artículo especial
Factores de riesgo para los tumores óseos malignos pediátricos
Risk factors for pediatric malignant bone tumors
J. Ferrís i Tortajadaa,b,
, O. Berbel Torneroa, J.A. Ortega Garcíaa, L. Claudio-Moralesd, J. García i Castelle, V. Martí Peralesf, L. Miranda Casasf
Autor para correspondencia
ferris_jos@gva.es
http://www.pehsu.org
Correspondencia: Dr. J. Ferrís i Tortajada. Unidad de Salud Medioambiental. Sección de Oncología Pediátrica. Hospital Universitario Materno-Infantil La Fe. Avda. Campanar, 21. 46009 Valencia. España.
http://www.pehsu.org
Correspondencia: Dr. J. Ferrís i Tortajada. Unidad de Salud Medioambiental. Sección de Oncología Pediátrica. Hospital Universitario Materno-Infantil La Fe. Avda. Campanar, 21. 46009 Valencia. España.
a Unidad de Salud Medioambiental Pediátrica. Hospital Universitario Virgen de la Arrixaca. Murcia. España
b Sección de Oncología Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. Unidad de Salud Medicoambiental Pediátrica. Hospital Universitario Virgen de la Arrixaca. Murcia. España
d Department of Community and Preventive Medicine. Mount Sinai School of Medicine. Nueva York. EE.UU. España
e Servicio de Anatomía Patológica. Hospital de Sagunto. Valencia. España
f Sección de Traumatología y Ortopedia Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. España
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España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Sección de Oncología Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. Unidad de Salud Medicoambiental Pediátrica. Hospital Universitario Virgen de la Arrixaca. Murcia. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Department of Community and Preventive Medicine. Mount Sinai School of Medicine. Nueva York. EE.UU. España" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía Patológica. Hospital de Sagunto. Valencia. España" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Sección de Traumatología y Ortopedia Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. 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España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Risk factors for pediatric malignant bone tumors" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-06-30" "fechaAceptado" => "2005-06-30" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186292" "palabras" => array:4 [ 0 => "Tumores óseos malignos pediátricos" 1 => "Osteosarcoma" 2 => "Sarcoma de Ewing" 3 => "Factores de riesgo" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186291" "palabras" => array:4 [ 0 => "Pediatric malignant bone tumour" 1 => "Osteosarcoma" 2 => "Ewing's sarcoma" 3 => "Risk factor" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p class="elsevierStyleSimplePara elsevierViewall">El cáncer es el resultado final de la interacción multifactorial de dos clases de determinantes, el genético (endógeno) y el ambiental (exógeno). El progreso evidenciado por la oncología pediátrica, durante las últimas décadas, también se ha reflejado en los tumores óseos malignos (TOM). Estos avances se centran en los aspectos diagnósticos y terapéuticos, pero no en los factores de riesgo (FR) implicados en su etiopatogenia.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La presente revisión tiene tres objetivos: <span class="elsevierStyleItalic">a)</span> actualizar el conocimiento de los FR asociados con los TOM durante la época pediátrica y adulta; <span class="elsevierStyleItalic">b)</span> divulgar entre todos nuestros compañeros los principales FR relacionados a los TOM, para fomentar su investigación, diagnóstico y futura prevención, y <span class="elsevierStyleItalic">c)</span> solicitar la ayuda de nuestros colegas para el proyecto de investigación <span class="elsevierStyleItalic">Medio ambiente y cáncer pediátrico</span>.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Revisión bibliográfica sistemática, de los últimos 30 años, de los FR implicados en la etiopatogenia de los TOM, obtenida del Medline, Cancerlit, Index Citation Science y Embase. Los perfiles de búsqueda utilizados han sido: <span class="elsevierStyleItalic">pediatric/ childhood malignant bone tumors, pediatric/childhood bone cancer/neoplasm, osteosarcoma/bone sarcoma/ Ewing's sarcoma and risk factors/etiology/epidemiology</span>. Se han seleccionado los artículos más interesantes y de sus referencias, las más relevantes.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Los TOM constituyen el 6-7% de los cánceres pediátricos. Las dos variedades más frecuentes son el osteosarcoma (OTS) y el sarcoma de Ewing (SE), con el 56 y el 34% de los casos, respectivamente. Los FR asociados con el OTS son los siguientes: <span class="elsevierStyleItalic">a)</span> patologías óseas preexistentes (enfermedad de Paget); <span class="elsevierStyleItalic">b)</span> factores genético-familiares (retinoblastoma hereditario, síndrome de Li-Fraumeni, syndrome de Rothmund-Thompson, síndrome de Bloom, OTS familiar y anemia de Diamond-Blackfan); <span class="elsevierStyleItalic">c)</span> factores químicos (sustancias antineoplásicas); <span class="elsevierStyleItalic">d)</span> factores físicos (radiación ionizante); <span class="elsevierStyleItalic">e)</span> factores biológicos; <span class="elsevierStyleItalic">f)</span> ocupaciones parentales, y <span class="elsevierStyleItalic">g)</span> otros factores (implantes óseos artificiales y traumatismos). Los FR asociados con el SE son los siguientes: <span class="elsevierStyleItalic">a)</span> étnico-culturales (raza blanca); <span class="elsevierStyleItalic">b)</span> factores genéticos; <span class="elsevierStyleItalic">c)</span> ocupaciones parentales (exposiciones laborables a herbicidas, pesticidas y fertilizantes); <span class="elsevierStyleItalic">d)</span> antecedents obstétricos maternos, y <span class="elsevierStyleItalic">e)</span> otros factores (tabaquismo parental y hernias inguinales).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La mayoría de las causas de los TOM son desconocidas. Los principales FR implicados, con mayor o menor evidencia científica, en la etiopatogenia del OTS son: enfermedad de Paget, retinoblastoma hereditario, síndrome de Li-Fraumeni, sustancias antineoplásicas y radiación ionizante. Los principales FR asociados al SE son: raza blanca, exposiciones ocupacionales parentales, tabaquismo parental y antecedente de hernia inguinal intervenida. Las principales dificultades para avanzar en el conocimiento de los FR relacionados con el desarrollo de los TOM son: <span class="elsevierStyleItalic">a)</span> su origen multifactorial; <span class="elsevierStyleItalic">b)</span> la baja prevalencia poblacional; <span class="elsevierStyleItalic">c)</span> la inexistente formación en salud medioambiental pediátrica, y <span class="elsevierStyleItalic">d)</span> los escasos presupuestos económicos públicos o privados destinados a tal finalidad.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Cancer is the result of the interaction of two kinds of determinants: genetic (endogenous) and environmental (exogenous). In the last few decades, pediatric oncology as a whole has progressed, including knowledge of malignant osseous tumors (MOT). Although advances have been made in diagnostic and therapeutic aspects, little progress has taken place in our knowledge of the risk factors involved in their etiopathogenesis.</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">This review has three objectives: <span class="elsevierStyleItalic">a)</span> to provide an update on MOT-related risk factors in the child and adult population; <span class="elsevierStyleItalic">b)</span> to disseminate knowledge of the main MOT-related risk factors among our colleagues in order to promote research into these factors, diagnosis and future prevention, and <span class="elsevierStyleItalic">c)</span> to request help from our colleagues in the <span class="elsevierStyleItalic">Environment and Pediatric Cancer</span> research project.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature published in the last 30 years on risk factors implicated in the etiopathogenesis of MOT, using Medline, Cancerlit, Science Citation Index and Embase. The search profiles used were: <span class="elsevierStyleItalic">pediatric/childhood malignant bone tumors, pediatric/ childhood bone cancer/neoplasm, osteosarcoma/bone sarcoma/Ewing's sarcoma and risk factors/etiology/epidemiology</span>. The most interesting articles were selected and the most relevant references contained therein were retrieved.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">MOT represent 6-7% of all pediatric neoplasms. The most frequent types are osteosarcoma (OS) and Ewing's sarcoma (ES), representing 56 % and 34 % respectively. OS-related risk factors are the following: <span class="elsevierStyleItalic">a)</span> previous osseous disease (Paget's disease); <span class="elsevierStyleItalic">b)</span> familial-genetic factors (hereditary retinoblastoma, Li-Fraumeni syndrome, Rothmund- Thompson syndrome, Bloom syndrome, familial OS, Diamond-Blackfan anemia); <span class="elsevierStyleItalic">c)</span> chemical factors (antineoplastic drugs); <span class="elsevierStyleItalic">d)</span> physical factors (ionizing radiation); <span class="elsevierStyleItalic">e)</span> biologic factors; <span class="elsevierStyleItalic">f)</span> parental occupation, and g) other factors (artificial osseous implants and traumatisms). ES-related risk factors are the following: <span class="elsevierStyleItalic">a)</span> ethnic-cultural (Caucasian race); <span class="elsevierStyleItalic">b)</span> genetic factors; <span class="elsevierStyleItalic">c)</span> parental occupation (herbicide, pesticide ad fertilizer exposure); <span class="elsevierStyleItalic">d)</span> maternal obstetric history, and <span class="elsevierStyleItalic">e)</span> other factors (parental smoking and inguinal hernia).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Most causes of MOT are unknown. Based on different levels of scientific evidence, the main factors implicated in the etiopathogenesis of OS are: Paget's disease, hereditary retinoblastoma, Li-Fraumeni syndrome, antineoplastic drugs, and ionizing radiation. The main factors related to ES are: Caucasian race, parental occupation, parental smoking, and surgery for inguinal hernia. The main obstacles to greater knowledge of MOT-related factors are: <span class="elsevierStyleItalic">a)</span> their multiple origin; <span class="elsevierStyleItalic">b)</span> the low prevalence in the population; <span class="elsevierStyleItalic">c)</span> lack of environmental health training in pediatrics, and <span class="elsevierStyleItalic">d)</span> the low public and private investment in this research field.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Trabajo financiado parcialmente por la Fundación Científica de la AECC (MAPACE-2004) y por el Programa de Capacitación en Salud Ambiental y Ocupacional del Mount Sinai Medical Center, con el apoyo del Fogarty International Center (NIH TW00640).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:59 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 11 | 21 |
| 2024 Octubre | 62 | 66 | 128 |
| 2024 Septiembre | 71 | 103 | 174 |
| 2024 Agosto | 74 | 109 | 183 |
| 2024 Julio | 57 | 75 | 132 |
| 2024 Junio | 63 | 63 | 126 |
| 2024 Mayo | 72 | 82 | 154 |
| 2024 Abril | 60 | 82 | 142 |
| 2024 Marzo | 44 | 77 | 121 |
| 2024 Febrero | 63 | 71 | 134 |
| 2024 Enero | 41 | 62 | 103 |
| 2023 Diciembre | 39 | 42 | 81 |
| 2023 Noviembre | 39 | 54 | 93 |
| 2023 Octubre | 44 | 44 | 88 |
| 2023 Septiembre | 44 | 53 | 97 |
| 2023 Agosto | 56 | 38 | 94 |
| 2023 Julio | 44 | 37 | 81 |
| 2023 Junio | 38 | 43 | 81 |
| 2023 Mayo | 49 | 31 | 80 |
| 2023 Abril | 28 | 29 | 57 |
| 2023 Marzo | 46 | 43 | 89 |
| 2023 Febrero | 27 | 27 | 54 |
| 2023 Enero | 30 | 38 | 68 |
| 2022 Diciembre | 44 | 52 | 96 |
| 2022 Noviembre | 43 | 47 | 90 |
| 2022 Octubre | 44 | 51 | 95 |
| 2022 Septiembre | 41 | 95 | 136 |
| 2022 Agosto | 47 | 69 | 116 |
| 2022 Julio | 26 | 76 | 102 |
| 2022 Junio | 27 | 79 | 106 |
| 2022 Mayo | 37 | 40 | 77 |
| 2022 Abril | 41 | 56 | 97 |
| 2022 Marzo | 39 | 67 | 106 |
| 2022 Febrero | 23 | 57 | 80 |
| 2022 Enero | 30 | 46 | 76 |
| 2021 Diciembre | 22 | 78 | 100 |
| 2021 Noviembre | 38 | 76 | 114 |
| 2021 Octubre | 53 | 90 | 143 |
| 2021 Septiembre | 41 | 56 | 97 |
| 2021 Agosto | 50 | 38 | 88 |
| 2021 Julio | 66 | 40 | 106 |
| 2021 Junio | 42 | 46 | 88 |
| 2021 Mayo | 36 | 43 | 79 |
| 2021 Abril | 70 | 78 | 148 |
| 2021 Marzo | 105 | 35 | 140 |
| 2021 Febrero | 98 | 29 | 127 |
| 2021 Enero | 99 | 21 | 120 |
| 2020 Diciembre | 73 | 38 | 111 |
| 2020 Noviembre | 84 | 30 | 114 |
| 2020 Octubre | 37 | 12 | 49 |
| 2020 Septiembre | 17 | 19 | 36 |
| 2020 Agosto | 18 | 12 | 30 |
| 2020 Julio | 34 | 15 | 49 |
| 2020 Junio | 26 | 12 | 38 |
| 2020 Mayo | 44 | 22 | 66 |
| 2020 Abril | 35 | 28 | 63 |
| 2020 Marzo | 25 | 12 | 37 |
| 2020 Febrero | 23 | 17 | 40 |
| 2020 Enero | 26 | 27 | 53 |
| 2019 Diciembre | 62 | 24 | 86 |
| 2019 Noviembre | 54 | 25 | 79 |
| 2019 Octubre | 21 | 36 | 57 |
| 2019 Septiembre | 17 | 31 | 48 |
| 2019 Agosto | 23 | 22 | 45 |
| 2019 Julio | 34 | 50 | 84 |
| 2019 Junio | 36 | 35 | 71 |
| 2019 Mayo | 62 | 39 | 101 |
| 2019 Abril | 76 | 58 | 134 |
| 2019 Marzo | 16 | 14 | 30 |
| 2019 Febrero | 23 | 13 | 36 |
| 2019 Enero | 22 | 12 | 34 |
| 2018 Diciembre | 18 | 23 | 41 |
| 2018 Noviembre | 64 | 20 | 84 |
| 2018 Octubre | 47 | 22 | 69 |
| 2018 Septiembre | 20 | 9 | 29 |
| 2018 Agosto | 1 | 0 | 1 |
| 2018 Julio | 3 | 0 | 3 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 4 | 0 | 4 |
| 2018 Abril | 11 | 0 | 11 |
| 2018 Marzo | 6 | 0 | 6 |
| 2018 Febrero | 13 | 0 | 13 |
| 2018 Enero | 10 | 0 | 10 |
| 2017 Diciembre | 11 | 0 | 11 |
| 2017 Noviembre | 10 | 0 | 10 |
| 2017 Octubre | 5 | 0 | 5 |
| 2017 Septiembre | 13 | 0 | 13 |
| 2017 Agosto | 7 | 0 | 7 |
| 2017 Julio | 9 | 1 | 10 |
| 2017 Junio | 16 | 33 | 49 |
| 2017 Mayo | 22 | 23 | 45 |
| 2017 Abril | 13 | 20 | 33 |
| 2017 Marzo | 18 | 25 | 43 |
| 2017 Febrero | 15 | 24 | 39 |
| 2017 Enero | 18 | 13 | 31 |
| 2016 Diciembre | 28 | 9 | 37 |
| 2016 Noviembre | 34 | 21 | 55 |
| 2016 Octubre | 34 | 16 | 50 |
| 2016 Septiembre | 22 | 21 | 43 |
| 2016 Agosto | 21 | 9 | 30 |
| 2016 Julio | 21 | 15 | 36 |
| 2016 Junio | 3 | 14 | 17 |
| 2016 Mayo | 4 | 18 | 22 |
| 2016 Abril | 3 | 0 | 3 |
| 2016 Marzo | 6 | 0 | 6 |
| 2016 Febrero | 1 | 24 | 25 |
| 2016 Enero | 1 | 28 | 29 |
| 2015 Diciembre | 6 | 24 | 30 |
| 2015 Noviembre | 2 | 24 | 26 |
| 2015 Octubre | 6 | 13 | 19 |
| 2015 Septiembre | 12 | 0 | 12 |
| 2015 Agosto | 5 | 11 | 16 |
| 2015 Julio | 16 | 8 | 24 |
| 2015 Junio | 15 | 5 | 20 |
| 2015 Mayo | 21 | 16 | 37 |
| 2015 Abril | 14 | 13 | 27 |
| 2015 Marzo | 20 | 17 | 37 |
| 2015 Febrero | 19 | 17 | 36 |
| 2015 Enero | 23 | 1 | 24 |
| 2014 Diciembre | 25 | 3 | 28 |
| 2014 Noviembre | 24 | 2 | 26 |
| 2014 Octubre | 27 | 3 | 30 |
| 2014 Septiembre | 31 | 4 | 35 |
| 2014 Agosto | 42 | 2 | 44 |
| 2014 Julio | 42 | 2 | 44 |
| 2014 Junio | 74 | 4 | 78 |
| 2014 Mayo | 90 | 3 | 93 |
| 2014 Abril | 65 | 4 | 69 |
| 2014 Marzo | 77 | 13 | 90 |
| 2014 Febrero | 55 | 12 | 67 |
| 2014 Enero | 75 | 8 | 83 |
| 2013 Diciembre | 76 | 7 | 83 |
| 2013 Noviembre | 95 | 7 | 102 |
| 2013 Octubre | 63 | 6 | 69 |
| 2013 Septiembre | 69 | 12 | 81 |
| 2013 Agosto | 97 | 13 | 110 |
| 2013 Julio | 44 | 11 | 55 |
| 2013 Junio | 4 | 4 | 8 |
| 2013 Mayo | 4 | 9 | 13 |
| 2013 Abril | 9 | 3 | 12 |
| 2013 Marzo | 8 | 1 | 9 |
| 2013 Febrero | 27 | 1 | 28 |
| 2013 Enero | 28 | 1 | 29 |
| 2012 Diciembre | 19 | 0 | 19 |
| 2012 Noviembre | 18 | 0 | 18 |
| 2012 Octubre | 8 | 2 | 10 |
| 2012 Septiembre | 3 | 1 | 4 |
| 2005 Diciembre | 4806 | 0 | 4806 |
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