Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Oncologist. 2019 Sep;24(9):e891-e897. doi: 10.1634/theoncologist.2018-0747. Epub 2019 Mar 21.
Research on cancer survivorship associated with nasopharyngeal carcinoma (NPC) is rare. We aimed to elucidate the risk of ischemic stroke in 5-year survivors of NPC following radiotherapy (RT) or concurrent chemoradiation therapy (CCRT).
SUBJECTS, MATERIALS, AND METHODS: NPC survivors, defined as those who survived longer than 5 years after diagnosis, were identified and matched at a 1:5 ratio with normal controls from the Longitudinal Health Insurance Database 2005 of Taiwan. The stratified Cox regression models were used to access the risk of ischemic stroke, with adjustment for age, treatment modality, comorbidities, and socioeconomic characteristics.
From 2000 to 2005, a total of 3,016 NPC survivors who had received RT ( = 959) or CCRT ( = 2,057) and 15,080 controls were matched for age, sex, income, and urbanization level. The risk of ischemic stroke was significantly higher in the NPC survivor cohort than in the control cohort. Stroke was positively related to death. Moreover, the age onset of stroke for NPC survivors was 10 years earlier than that for the general population.
Not only was the stroke risk in NPC survivors higher than that in the general population, but the onset age was also 10 years earlier. Future survivorship care should include ischemic stroke as a late complication, for its proper prevention and management.
Nasopharyngeal carcinoma (NPC) is endemic in Taiwan, and its 5-year survival is 65.2%. With the increased 5-year cancer survivors, survivorship has become an important issue. However, research on NPC survivorship is very rare. To the authors' knowledge, this is the first population-based study on long-term NPC survivors. This study's results indicated that not only was the risk of ischemic stroke in NPC survivors at least triple that of the general population, but the onset age was also 10 years earlier. These results may provide solid evidence that survivorship care guidelines should include stroke as a late complication in 5-year NPC survivors, for its proper prevention and management.
关于鼻咽癌（NPC）相关癌症生存者的研究很少。我们旨在阐明放疗（RT）或同期放化疗（CCRT）后 NPC 5 年生存者发生缺血性中风的风险。
受试者、材料和方法：从台湾纵向健康保险数据库 2005 年中确定 NPC 生存者，定义为诊断后存活时间超过 5 年的患者，并以 1:5 的比例与正常对照相匹配。使用分层 Cox 回归模型评估缺血性中风的风险，并调整年龄、治疗方式、合并症和社会经济特征。
2000 年至 2005 年，共 3016 例接受 RT（=959）或 CCRT（=2057）的 NPC 幸存者和 15080 名对照者按年龄、性别、收入和城市化水平进行匹配。NPC 幸存者队列的缺血性中风风险明显高于对照组。中风与死亡呈正相关。此外，NPC 幸存者中风的发病年龄比一般人群早 10 年。
不仅 NPC 幸存者的中风风险高于一般人群，而且发病年龄也早 10 年。未来的生存者护理应将中风作为一种晚期并发症纳入其中，以便进行适当的预防和管理。
鼻咽癌（NPC）在台湾流行，其 5 年生存率为 65.2%。随着癌症 5 年生存者的增加，生存问题已成为一个重要问题。然而，关于 NPC 生存者的研究很少。据作者所知，这是第一项基于人群的关于长期 NPC 生存者的研究。本研究结果表明，不仅 NPC 幸存者发生缺血性中风的风险至少是一般人群的三倍，而且发病年龄也早 10 年。这些结果可能为生存者护理指南提供有力证据，即应将中风作为 5 年 NPC 幸存者的晚期并发症纳入其中，以便进行适当的预防和管理。
