Affiliations of authors: Danish Cancer Society Research Center, Copenhagen, Denmark (KR, LM, JHO); Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN (JDB); National Council on Radiation Protection and Measurements, Bethesda, MD (JDB); Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark (LK); Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark (ME).
J Natl Cancer Inst. 2014 May 21;106(6):dju110. doi: 10.1093/jnci/dju110. Print 2014 Jun.
Cardiovascular disease has emerged as a serious late effect in survivors of adolescent and young adult cancer, but risk has not been quantified comprehensively in a population-based setting.
In the Danish Cancer Registry, we identified 43153 1-year survivors of cancer diagnosed at ages 15 to 39 years (1943-2009) and alive in 1977; from the Danish Civil Registration System, we randomly selected a comparison cohort of the same age and sex. Subjects were linked to the Danish Patient Register, and observed numbers of first hospitalizations for cardiovascular disease (International Classification of Diseases, Tenth Revision codes I10-I79) were compared with the expected numbers derived from the comparison cohort. We calculated the absolute excess risks attributable to status as a survivor of cancer and standardized hospitalization rate ratios (RRs). All statistical tests were two-sided.
During follow-up, 10591 survivors (24.5%) were discharged from the hospital with cardiovascular disease, whereas 8124 were expected (RR = 1.30; 95% confidence interval [CI)] = 1.28 to 1.33; P < .001). The absolute excess risks were 400 and 350 extra cases of cardiovascular disease per 100000 person-years for people aged 20 to 59 and 60 to 79 years at discharge, respectively. Survivors of Hodgkin lymphoma experienced high risks for being hospitalized with valvular disease (RR = 12.2; 95% CI = 9.9 to 15.0; P < .001). Survivors of leukemia had high risks for cerebral hemorrhage (RR = 10.3; 95% CI = 5.5 to 19.1; P < .001) and cardiomyopathy (RR = 8.6; 95% CI = 4.3 to 17.3; P < .001).
Survivors of adolescent and young adult cancer are at increased risk for cardiovascular disease throughout life, although each main type of adolescent and young adult cancer had its own risk profile.
心血管疾病已成为青少年和年轻成年癌症幸存者的严重晚期效应，但在基于人群的环境中尚未全面量化风险。
在丹麦癌症登记处，我们确定了 43153 名年龄在 15 至 39 岁（1943-2009 年）且在 1977 年存活的癌症 1 年幸存者；从丹麦民事登记系统中，我们随机选择了相同年龄和性别的对照组。将受试者与丹麦患者登记处相联系，并比较了首次因心血管疾病（国际疾病分类，第十版代码 I10-I79）住院的实际人数与对照组预期的人数。我们计算了归因于癌症幸存者身份的绝对超额风险，并标准化了住院率比（RR）。所有统计检验均为双侧。
在随访期间，10591 名幸存者（24.5%）因心血管疾病出院，而预期为 8124 人（RR = 1.30；95%置信区间[CI]为 1.28 至 1.33；P <.001）。对于出院时年龄在 20 至 59 岁和 60 至 79 岁的人群，每 100000 人年分别有 400 和 350 例心血管疾病的绝对超额病例。霍奇金淋巴瘤幸存者因瓣膜疾病住院的风险较高（RR = 12.2；95%CI = 9.9 至 15.0；P <.001）。白血病幸存者因脑出血（RR = 10.3；95%CI = 5.5 至 19.1；P <.001）和心肌病（RR = 8.6；95%CI = 4.3 至 17.3；P <.001）的风险较高。
青少年和年轻成年癌症幸存者一生都有患心血管疾病的风险增加，尽管每种主要类型的青少年和年轻成年癌症都有其自身的风险特征。
