儿童癌症幸存者晚期蒽环类药物心脏毒性的无创评估
Noninvasive evaluation of late anthracycline cardiac toxicity in childhood cancer survivors.
作者信息
Hudson Melissa M, Rai Shesh N, Nunez Cesar, Merchant Thomas E, Marina Neyssa M, Zalamea Nia, Cox Cheryl, Phipps Sean, Pompeu Ronald, Rosenthal David
机构信息
Department of Hematology Oncology, Division of Behavioral Medicine, St Jude Children's Research Hospital, the University of Tennessee, College of Medicine, Memphis, TN 38105, USA.
出版信息
J Clin Oncol. 2007 Aug 20;25(24):3635-43. doi: 10.1200/JCO.2006.09.7451.
UNLABELLED
PURPOSEl: Childhood cancer survivors treated with anthracyclines and cardiac radiation are at risk for late-onset cardiotoxicity. The purpose of this study was to delineate the relationship between clinical factors and abnormalities of noninvasive cardiac testing (NICT).
PATIENTS AND METHODS
Participants were recruited from a long-term follow-up clinic. Study measures comprised physical examination, laboratory evaluation, echocardiogram, and ECG. Mean fractional shortening (FS) and afterload were compared for survivors who did (at risk [AR]) and did not (no risk [NR]) receive potentially cardiotoxic modalities, and with values expected for comparable age- and sex-matched controls.
RESULTS
The 278 study participants (mean age, 18.1 years; median age, 16.8 years; range, 7.5 to 39.7 years) included 223 survivors AR for cardiotoxicity after treatment with anthracyclines (median dose +/- standard deviation [SD], 202 +/- 109 mg/m(2)) and/or cardiac radiation. Mean FS (+/- SD) was lower for AR (0.33 +/- 0.06) compared with NR survivors (0.36 +/- 0.05; P = .004) and normative controls (0.36 +/- 0.04; P < .001). Mean afterload (+/- SD) was higher for AR (58 +/- 21 g/cm(2)) compared with NR survivors (46 +/- 15 g/cm(2); P < .001) and normative controls (48 +/- 13 g/cm(2); P < .001). The distribution of FS and afterload among NR survivors did not differ from that of controls. After adjustment for age group at diagnosis and time since completion of therapy, anthracycline dose predicted decline in distribution of FS (P < .001) and increase in distribution of afterload (P < .001). Treatment with anthracycline doses >or= 100 mg/m(2) increased the risk of abnormal NICT; survivors who received >or= 270 mg/m(2) had a 4.5-fold excess risk of abnormal NICT (95% CI, 2.1 to 9.6) compared with controls.
CONCLUSION
Childhood cancer survivors treated with anthracycline doses >or= 270 mg/m(2) are at greatest risk for abnormalities of FS and afterload.
未标记
目的：接受蒽环类药物和心脏放疗的儿童癌症幸存者有发生迟发性心脏毒性的风险。本研究的目的是阐明临床因素与非侵入性心脏检查（NICT）异常之间的关系。
患者与方法
参与者从长期随访诊所招募。研究措施包括体格检查、实验室评估、超声心动图和心电图。比较接受（有风险[AR]）和未接受（无风险[NR]）潜在心脏毒性治疗方式的幸存者的平均缩短分数（FS）和后负荷，并与年龄和性别匹配的对照者的预期值进行比较。
结果
278名研究参与者（平均年龄18.1岁；中位年龄16.8岁；范围7.5至39.7岁）包括223名接受蒽环类药物（中位剂量±标准差[SD]，202±109mg/m²）和/或心脏放疗后有心脏毒性风险的幸存者。与无风险幸存者（0.36±0.05；P = 0.004）和正常对照者（0.36±0.04；P < 0.001）相比，有风险者的平均FS（±SD）较低（0.33±0.06）。与无风险幸存者（46±15g/cm²；P < 0.001）和正常对照者（48±13g/cm²；P < 0.001）相比，有风险者的平均后负荷（±SD）较高（58±21g/cm²）。无风险幸存者中FS和后负荷的分布与对照者无差异。在调整诊断时的年龄组和治疗结束后的时间后，蒽环类药物剂量可预测FS分布的下降（P < 0.001）和后负荷分布的增加（P < 0.001）。蒽环类药物剂量≥100mg/m²的治疗增加了NICT异常的风险；与对照者相比，接受≥270mg/m²的幸存者NICT异常的风险高出4.5倍（95%CI，2.1至9.6）。
结论
接受蒽环类药物剂量≥270mg/m²治疗的儿童癌症幸存者发生FS和后负荷异常的风险最大。
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