Cardiology Working Group, Society of Junior Doctors, Athens, Greece
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Oncologist. 2018 Aug;23(8):965-973. doi: 10.1634/theoncologist.2017-0502. Epub 2018 Mar 28.
Long-term childhood cancer survivors (CCS) are at increased risk of adverse cardiovascular events; however, there is a paucity of risk-stratification tools to identify those at higher-than-normal risk.
SUBJECTS, MATERIALS, AND METHODS: This was a population-based study using data from the Surveillance, Epidemiology, and End Results Program (1973-2013). Long-term CCS (age at diagnosis ≤19 years, survival ≥5 years) were followed up over a median time period of 12.3 (5-40.9) years. Independent predictors of cardiovascular mortality (CVM) were combined into a risk score, which was developed in a derivation set ( = 22,374), and validated in separate patient registries ( = 6,437).
In the derivation registries, older age at diagnosis (≥10 years vs. reference group of 1-5 years), male sex, non-white race, a history of lymphoma, and a history of radiation were independently associated with an increased risk of CVM among long-term CCS ( < .05). A risk score derived from this model (Childhood and Adolescence Cancer Survivor CardioVascular score [CHACS-CV], range: 0-8) showed good discrimination for CVM (Harrell's C-index [95% confidence interval (CI)]: 0.73 [0.68-0.78], < .001) and identified a high-risk group (CHACS-CV ≥6), with cumulative CVM incidence over 30 years of 6.0% (95% CI: 4.3%-8.1%) versus 2.6% (95% CI: 1.8%-3.7%), and 0.7% (95% CI: 0.5%-1.0%) in the mid- (CHACS-CV = 4-5) and low-risk groups (CHACS-CV ≤3), respectively ( < .001). In the validation set, the respective cumulative incidence rates were 4.7%, 3.1%, and 0.8% ( < .001).
We propose a simple risk score that can be applied in everyday clinical practice to identify long-term CCS at increased cardiovascular risk, who may benefit from early cardiovascular screening, and risk-reduction strategies.
Childhood cancer survivors (CCS) are known to be at increased cardiovascular risk. Currently available prognostic tools focus on treatment-related adverse events and late development of congestive heart failure, but there is no prognostic model to date to estimate the risk of cardiovascular mortality among long-term CCS. A simple clinical tool is proposed for cardiovascular risk stratification of long-term CCS based on easily obtainable information from their medical history. This scoring system may be used as a first-line screening tool to assist health care providers in identifying those who may benefit from closer follow-up and enable timely deployment of preventive strategies.
长期儿童癌症幸存者（CCS）发生不良心血管事件的风险增加；然而，目前缺乏风险分层工具来识别那些风险高于正常水平的患者。
对象、材料和方法：这是一项基于人群的研究，使用了监测、流行病学和最终结果计划（1973-2013 年）的数据。长期 CCS（诊断时年龄≤19 岁，生存时间≥5 年）的中位随访时间为 12.3 年（5-40.9 年）。心血管死亡率（CVM）的独立预测因素被组合成一个风险评分，该评分在一个推导集（n=22374）中开发，并在单独的患者登记处进行验证（n=6437）。
在推导登记处，诊断时年龄较大（≥10 岁与参考组 1-5 岁）、男性、非白人种族、淋巴瘤病史和放疗史与长期 CCS 中 CVM 风险增加独立相关（ < .05）。从该模型得出的风险评分（儿童和青少年癌症幸存者心血管评分[CHACS-CV]，范围：0-8）在 CVM 方面具有良好的区分度（哈雷尔 C 指数[95%置信区间（CI）]：0.73[0.68-0.78]， < .001），并确定了一个高危组（CHACS-CV≥6），30 年内累积 CVM 发生率为 6.0%（95%CI：4.3%-8.1%），而中危组（CHACS-CV=4-5）和低危组（CHACS-CV≤3）分别为 2.6%（95%CI：1.8%-3.7%）和 0.7%（95%CI：0.5%-1.0%）（ < .001）。在验证集中，相应的累积发生率分别为 4.7%、3.1%和 0.8%（ < .001）。
我们提出了一种简单的风险评分，可以在日常临床实践中应用，以识别心血管风险增加的长期 CCS，他们可能受益于早期心血管筛查和风险降低策略。
儿童癌症幸存者（CCS）已知存在心血管风险增加的情况。目前可用的预后工具主要关注与治疗相关的不良事件和充血性心力衰竭的迟发性发展，但迄今为止尚无预后模型来估计长期 CCS 心血管死亡率的风险。基于病史中可获得的简单信息，提出了一种用于长期 CCS 心血管风险分层的简单临床工具。该评分系统可作为一线筛查工具，帮助医疗保健提供者识别那些可能受益于更密切随访的患者，并能够及时实施预防策略。
