Al-Kindi Sadeer G, Abu-Zeinah Ghaith F, Kim Chang H, Hejjaji Vittal, William Basem M, Caimi Paolo F, Oliveira Guilherme H
Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
Clin Lymphoma Myeloma Leuk. 2015 Dec;15(12):748-52. doi: 10.1016/j.clml.2015.07.638. Epub 2015 Aug 5.
Over the past decades, survival of patients with Hodgkin lymphoma (HL) has increased but remains curtailed by cardiovascular mortality (CVM). HL survivors at greatest risk for cardiovascular death have not been clearly identified. We sought to report trends of CVM identify HL survivors at highest risk.
The Surveillance, Epidemiology, and End Results (SEER) database was queried for all adult patients diagnosed with HL (age 20-49 years) between 1990 and 2011. The trend of CVM and disparities are presented.
Of 19,781 HL patients, 53% were male and 83% were white; patients had a mean age of 33 ± 8.3 years at diagnosis. Eighteen percent had stage I disease, 45% stage II, 18% stage III, and 15% stage IV. The risk for CVM was higher in blacks (adjusted hazard ratio [HR], 1.97; P = .002), men (adjusted HR, 2.2; P < .001), and patients with older age at diagnosis (adjusted HR, 1.073 per year; P < .001). CVM has decreased, with 5-year cumulative incidence decreasing from 1.17% in 1990 to 0.18% in 2006, averaging 7% per year (adjusted HR, 0.927; P < .001). This trend was seen only in patients with early disease (P < .001) but not with advanced disease (P = NS). CVM as a proportion of all-cause mortality increases sharply at 50 years of age, constituting more than 30% of all causes of death.
Despite an overall decrease in CVM in HL survivors over the last decades, older patients, black patients, and men, especially those who have advanced-stage disease at diagnosis, are at the highest risk of cardiovascular death. Cardiovascular screening and risk modification should be intensified in HL patients with these characteristics.
在过去几十年中，霍奇金淋巴瘤（HL）患者的生存率有所提高，但仍受心血管疾病死亡率（CVM）的限制。心血管死亡风险最高的HL幸存者尚未明确界定。我们试图报告CVM的趋势并确定风险最高的HL幸存者。
查询监测、流行病学和最终结果（SEER）数据库中1990年至2011年间诊断为HL的所有成年患者（年龄20 - 49岁）。呈现CVM的趋势和差异。
在19781例HL患者中，53%为男性，83%为白人；患者诊断时的平均年龄为33±8.3岁。18%为I期疾病，45%为II期，18%为III期，15%为IV期。黑人（校正风险比[HR]，1.97；P = 0.002）、男性（校正HR，2.2；P < 0.001）以及诊断时年龄较大的患者（校正HR，每年1.073；P < 0.001）的CVM风险更高。CVM有所下降，5年累积发病率从1990年的1.17%降至2006年的0.18%，平均每年下降7%（校正HR，0.927；P < 0.001）。这种趋势仅在早期疾病患者中可见（P < 0.001），而在晚期疾病患者中未见（P = 无显著性差异）。CVM占全因死亡率的比例在50岁时急剧上升，占所有死亡原因的30%以上。
尽管在过去几十年中HL幸存者的CVM总体有所下降，但老年患者、黑人患者和男性，尤其是那些诊断时患有晚期疾病的患者，心血管死亡风险最高。对于具有这些特征的HL患者，应加强心血管筛查和风险调整。
