Hau Eva M, Caccia Julien N, Kasteler Rahel, Spycher Ben, Suter Thomas, Ammann Roland A, von der Weid Nicolas X, Kuehni Claudia E
Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland / Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Swiss Med Wkly. 2019 Mar 10;149:w20012. doi: 10.4414/smw.2019.20012. eCollection 2019 Feb 25.
Cardiovascular diseases (CVD) increase late morbidity and mortality in survivors of acute lymphoblastic leukaemia (ALL). We compared the risk of CVD in ALL survivors to siblings, examined time trends, quantified treatment-related risks, and investigated whether risk extends beyond patients treated with anthracyclines and chest radiotherapy.
The Swiss Childhood Cancer Survivor Study assessed CVD by patient questionnaire in 5-year ALL survivors diagnosed between 1976 and 2005 and their siblings. Participants were asked whether a physician had ever told them that they had hypertension, arrhythmia, heart failure, myocardial infarction, angina pectoris, stroke, thrombosis or valvular problems. We investigated treatment-related risk factors for CVD using multivariable logistic regression, adjusting for demographic and socioeconomic factors, BMI, smoking, diabetes mellitus, alcohol consumption and physical activity.
We contacted 707 survivors and 1299 siblings, 511 (72%) and 709 (55%) of whom responded, respectively. Survivors had a higher risk of developing CVD than siblings (odds ratio [OR] 1.9, 95% confidence interval 1.3–2.8), in particular heart failure (OR 13.9, 1.8–107.4). Compared to patients treated 1976–85, the risk of CVD was 1.4 (0.7–2.8) for those treated 1985–1994 and 1.5 (0.6–3.7) for those treated 1995–2005. The overall CVD risks after anthracycline treatment (OR 3.1, 2.0–4.7), haematopoietic stem cell transplantation (OR 8.0, 2.4–26.9) or relapse (OR 4.1, 1.9–8.8) were increased compared to those of siblings, while the CVD risks of survivors treated without anthracycline or chest radiotherapy were similar (OR 1.0; 0.5–2.0).
Despite attempts to reduce cardiotoxicity in childhood cancer treatment, CVD risks in ALL survivors treated more recently do not seem to have declined.
心血管疾病（CVD）会增加急性淋巴细胞白血病（ALL）幸存者的晚期发病率和死亡率。我们比较了ALL幸存者与同胞患CVD的风险，研究了时间趋势，量化了与治疗相关的风险，并调查了风险是否超出接受蒽环类药物和胸部放疗的患者范围。
瑞士儿童癌症幸存者研究通过患者问卷对1976年至2005年间确诊的5年ALL幸存者及其同胞进行CVD评估。参与者被问及医生是否曾告知他们患有高血压、心律失常、心力衰竭、心肌梗死、心绞痛、中风、血栓形成或瓣膜问题。我们使用多变量逻辑回归研究CVD的治疗相关风险因素，并对人口统计学和社会经济因素、体重指数、吸烟、糖尿病、饮酒和身体活动进行调整。
我们联系了707名幸存者和1299名同胞，其中分别有511名（72%）和709名（55%）做出了回应。幸存者患CVD的风险高于同胞（比值比[OR]1.9，95%置信区间1.3 - 2.8），尤其是心力衰竭（OR 13.9，1.8 - 107.4）。与1976 - 1985年接受治疗的患者相比，1985 - 1994年接受治疗的患者患CVD的风险为1.4（0.7 - 2.8），1995 - 2005年接受治疗的患者为1.5（0.6 - 3.7）。与同胞相比，蒽环类药物治疗（OR 3.1，2.0 - 4.7）、造血干细胞移植（OR 8.0，2.4 - 26.9）或复发（OR 4.1，1.9 - 8.8）后总体CVD风险增加，而未接受蒽环类药物或胸部放疗的幸存者患CVD的风险相似（OR 1.0；0.5 - 2.0）。
尽管在儿童癌症治疗中试图降低心脏毒性，但近期接受治疗的ALL幸存者患CVD的风险似乎并未下降。
