Moser Elizabeth C, Noordijk Evert M, van Leeuwen Flora E, le Cessie Saskia, Baars Joke W, Thomas José, Carde Patrice, Meerwaldt Jacobus H, van Glabbeke Martine, Kluin-Nelemans Hanneke C
European Organization for Research on Treatment of Cancer (EORTC) Data Center, Brussels, Belgium.
Blood. 2006 Apr 1;107(7):2912-9. doi: 10.1182/blood-2005-08-3392. Epub 2005 Dec 8.
Cardiovascular disease frequently occurs after lymphoma therapy, but it is common in the general population too. Therefore, risk estimation requires comparison to population-based rates. We calculated risk by standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years based on general population rates (Continuous Morbidity Registry Nijmegen) in 476 (Dutch and Belgian) patients with aggressive non-Hodgkin lymphoma (NHL) treated with at least 6 cycles of doxorubicin-based chemotherapy in 4 European Organization for Research on Treatment of Cancer (EORTC) trials (1980-1999). Cumulative incidence of cardiovascular disease, estimated in a competing risk model, was 12% at 5 years and 22% at 10 years (median follow-up, 8.4 years). Risk of chronic heart failure appeared markedly increased (SIR, 5.4; 95% CI, 4.1-6.9) with an AER of 208 excess cases per 10 000 person-years, whereas risk of coronary artery disease matched the general population (SIR, 1.2; 95% CI, 0.8-1.8; AER, 8 per 10 000 person-years). Risk of stroke was raised (SIR, 1.8; 95% CI, 1.1-2.4; AER, 15 per 10 000 person-years), especially after additional radiotherapy (> 40 Gy). Preexisting hypertension, NHL at young age, and salvage treatment increased risk of all cardiovascular events; the effect of radiotherapy was dose dependent. In conclusion, patients are at long-term high risk of chronic heart failure after NHL treatment and need therefore life-long monitoring. In contrast, risk of coronary artery disease appeared more age dependent than treatment related.
心血管疾病常在淋巴瘤治疗后出现，但在普通人群中也很常见。因此，风险评估需要与基于人群的发病率进行比较。我们根据4个欧洲癌症研究与治疗组织（EORTC）试验（1980 - 1999年）中476例（荷兰和比利时）接受至少6周期蒽环类药物化疗的侵袭性非霍奇金淋巴瘤（NHL）患者的普通人群发病率（奈梅亨连续发病登记处），通过标准化发病比（SIRs）和每10000人年的绝对超额风险（AERs）计算风险。在竞争风险模型中估计的心血管疾病累积发病率在5年时为12%，在10年时为22%（中位随访时间为8.4年）。慢性心力衰竭风险显著增加（SIR，5.4；95%CI，4.1 - 6.9），每10000人年有208例超额病例的AER，而冠状动脉疾病风险与普通人群相当（SIR，1.2；95%CI，0.8 - 1.8；AER，每10000人年8例）。中风风险升高（SIR，1.8；95%CI，1.1 - 2.4；AER，每10000人年15例），尤其是在额外放疗（>40 Gy）后。既往高血压、年轻时患NHL以及挽救性治疗会增加所有心血管事件的风险；放疗的影响呈剂量依赖性。总之，NHL治疗后患者长期处于慢性心力衰竭的高风险中，因此需要终身监测。相比之下，冠状动脉疾病风险似乎更多地取决于年龄而非治疗。
