Mulrooney Daniel A, Yeazel Mark W, Kawashima Toana, Mertens Ann C, Mitby Pauline, Stovall Marilyn, Donaldson Sarah S, Green Daniel M, Sklar Charles A, Robison Leslie L, Leisenring Wendy M
University of Minnesota Medical School and Masonic Cancer Center, Minneapolis, MN 55455, USA.
BMJ. 2009 Dec 8;339:b4606. doi: 10.1136/bmj.b4606.
To assess the incidence of and risks for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities among adult survivors of childhood and adolescent cancers.
Retrospective cohort study.
26 institutions that participated in the Childhood Cancer Survivor Study.
14,358 five year survivors of cancer diagnosed under the age of 21 with leukaemia, brain cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, kidney cancer, neuroblastoma, soft tissue sarcoma, or bone cancer between 1970 and 1986. Comparison group included 3899 siblings of cancer survivors.
Participants or their parents (in participants aged less than 18 years) completed a questionnaire collecting information on demographic characteristics, height, weight, health habits, medical conditions, and surgical procedures occurring since diagnosis. The main outcome measures were the incidence of and risk factors for congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities in survivors of cancer compared with siblings.
Survivors of cancer were significantly more likely than siblings to report congestive heart failure (hazard ratio (HR) 5.9, 95% confidence interval 3.4 to 9.6; P<0.001), myocardial infarction (HR 5.0, 95% CI 2.3 to 10.4; P<0.001), pericardial disease (HR 6.3, 95% CI 3.3 to 11.9; P<0.001), or valvular abnormalities (HR 4.8, 95% CI 3.0 to 7.6; P<0.001). Exposure to 250 mg/m(2) or more of anthracyclines increased the relative hazard of congestive heart failure, pericardial disease, and valvular abnormalities by two to five times compared with survivors who had not been exposed to anthracyclines. Cardiac radiation exposure of 1500 centigray or more increased the relative hazard of congestive heart failure, myocardial infarction, pericardial disease, and valvular abnormalities by twofold to sixfold compared to non-irradiated survivors. The cumulative incidence of adverse cardiac outcomes in cancer survivors continued to increase up to 30 years after diagnosis.
Survivors of childhood and adolescent cancer are at substantial risk for cardiovascular disease. Healthcare professionals must be aware of these risks when caring for this growing population.
评估儿童期和青少年期癌症成年幸存者中充血性心力衰竭、心肌梗死、心包疾病和瓣膜异常的发病率及风险。
回顾性队列研究。
参与儿童癌症幸存者研究的26家机构。
14358名21岁前被诊断患有白血病、脑癌、霍奇金淋巴瘤、非霍奇金淋巴瘤、肾癌、神经母细胞瘤、软组织肉瘤或骨癌的癌症五年幸存者，这些患者在1970年至1986年间患病。对照组包括3899名癌症幸存者的兄弟姐妹。
参与者或其父母（年龄小于18岁的参与者）完成一份问卷，收集自诊断以来的人口统计学特征、身高、体重、健康习惯、医疗状况和手术情况等信息。主要结局指标是癌症幸存者与兄弟姐妹相比充血性心力衰竭、心肌梗死、心包疾病和瓣膜异常的发病率及危险因素。
癌症幸存者比其兄弟姐妹更有可能报告充血性心力衰竭（风险比（HR）5.9，95%置信区间3.4至9.6；P<0.001）、心肌梗死（HR 5.0，95% CI 2.3至10.4；P<0.001）、心包疾病（HR 6.3，95% CI 3.3至11.9；P<0.001）或瓣膜异常（HR 4.8，95% CI 3.0至7.6；P<0.001）。与未接触过蒽环类药物的幸存者相比，接触250mg/m²或更多蒽环类药物会使充血性心力衰竭、心包疾病和瓣膜异常的相对风险增加2至5倍。与未接受放疗的幸存者相比，接受1500厘戈瑞或更高剂量心脏放疗会使充血性心力衰竭、心肌梗死、心包疾病和瓣膜异常的相对风险增加2至6倍。癌症幸存者不良心脏结局的累积发病率在诊断后30年内持续上升。
儿童期和青少年期癌症幸存者患心血管疾病的风险很大。医疗保健专业人员在照顾这一不断增长的人群时必须意识到这些风险。
Zotero 插件
