Olsen Morten, Garne Ester, Sværke Claus, Søndergaard Lars, Nissen Henrik, Andersen Henrik Ø, Hjortdal Vibeke E, Johnsen Søren P, Videbæk Jørgen
1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
2 Department of Paediatrics, Hospital Lillebaelt, Kolding, Denmark.
Cardiol Young. 2014 Feb;24(1):40-6. doi: 10.1017/S1047951112002144. Epub 2013 Jan 18.
We aimed to assess cancer risk in congenital heart defect patients, with and without Down's syndrome, compared with the general population.
We identified all patients born and diagnosed with congenital heart defects from 1977 to 2008 using the Danish National Registry of Patients, covering all Danish hospitals. We compared cancer incidence in the congenital heart defect cohort with that expected in the general population (∼5.5 million) using the Danish Cancer Registry, and computed age- and gender-standardised incidence ratios.
We identified 15,905 congenital heart defect patients, contributing a total of 151,172 person-years at risk; the maximum length of follow-up was 31 years (median 8 years). In all, 53 patients were diagnosed with cancer, including 30 female and 23 male patients (standardised incidence ratio = 1.63; 95% confidence interval: 1.22-2.13). Risks were increased for leukaemia, brain tumours, and basal cell carcinoma. After excluding 801 patients with Down's syndrome, the standardised incidence ratio was 1.19 (95% confidence interval: 0.84-1.64). In the subgroup of 5660 non-Down's syndrome patients undergoing cardiac surgery or catheter-based interventions, the standardised incidence ratio was 1.45 (95% confidence interval: 0.86-2.29).
The overall risk of cancer among congenital heart defect patients without Down's syndrome was not statistically significantly elevated. Cancer risk in the congenital heart defect cohort as a whole, including patients with Down's syndrome, was increased compared with the general population, although the absolute risk was low. Studies with longer follow-up and more information on radiation doses are needed to further examine a potential cancer risk associated with diagnostic radiation exposure.
我们旨在评估患有和未患有唐氏综合征的先天性心脏病患者与普通人群相比的癌症风险。
我们利用丹麦国家患者登记处识别出1977年至2008年期间出生并被诊断患有先天性心脏病的所有患者，该登记处涵盖了丹麦所有医院。我们使用丹麦癌症登记处将先天性心脏病队列中的癌症发病率与普通人群（约550万）的预期发病率进行比较，并计算年龄和性别标准化发病率比。
我们识别出15905例先天性心脏病患者，共产生151172人年的风险；最长随访时间为31年（中位数为8年）。共有53例患者被诊断患有癌症，其中包括30例女性和23例男性患者（标准化发病率比 = 1.63；95%置信区间：1.22 - 2.13）。白血病、脑肿瘤和基底细胞癌的风险增加。排除801例唐氏综合征患者后，标准化发病率比为1.19（95%置信区间：0.84 - 1.64）。在5660例接受心脏手术或导管介入治疗的非唐氏综合征患者亚组中，标准化发病率比为1.45（95%置信区间：0.86 - 2.29）。
无唐氏综合征的先天性心脏病患者的总体癌症风险在统计学上没有显著升高。包括唐氏综合征患者在内的先天性心脏病队列的癌症风险与普通人群相比有所增加，尽管绝对风险较低。需要进行更长随访时间且有更多辐射剂量信息的研究，以进一步研究与诊断性辐射暴露相关的潜在癌症风险。
