儿童癌症幸存者的心脏代谢风险：来自儿童肿瘤学组的报告。
Cardiometabolic Risk in Childhood Cancer Survivors: A Report from the Children's Oncology Group.
机构信息
Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
University of Miami Miller School of Medicine, Miami, Florida.
出版信息
Cancer Epidemiol Biomarkers Prev. 2022 Mar 1;31(3):536-542. doi: 10.1158/1055-9965.EPI-21-0360.
BACKGROUND
Childhood cancer survivors are at risk for cardiovascular disease. We assessed the burden of potentially modifiable cardiometabolic risk factors (CRF) among survivors compared with population-matched controls.
METHODS
Survivors previously enrolled on Pediatric Oncology Group protocols 9404, 9425, 9426, 9754, and Dana-Farber Cancer Institute 95-01 from 1996 to 2001 with acute lymphoblastic leukemia/lymphoma, Hodgkin lymphoma, or osteosarcoma were prospectively assessed for the prevalence of CRFs and compared with an age, sex, and race/ethnicity-matched 2013 National Health and Nutrition Examination Survey (NHANES) population. We estimated future predicted cardiovascular risk based on general population (e.g., Framingham) and Childhood Cancer Survivor Study (CCSS) models.
RESULTS
Compared with NHANES (n = 584), survivors [n = 164; 44.5% female, median age 28 years (range, 16-38 years); median 17.4 years (range, 13-22 years) since cancer diagnosis; median doxorubicin dose 300 mg/m2; 30.5% chest radiation] had similar rates of obesity, diabetes, and dyslipidemia, but more prehypertension/hypertension (38.4% vs. 30.1%, P = 0.044). Survivors had fewer metabolic syndrome features compared with NHANES (≥2 features: 26.7% vs. 55.9%; P < 0.001). Survivors were more physically active and smoked tobacco less (both P < 0.0001). Therefore, general population cardiovascular risk scores were lower for survivors versus NHANES. However, with CCSS models, 30.5% of survivors were at moderate risk of ischemic heart disease, and >95% at moderate/high risk for heart failure, with a 9% to 12% predicted incidence of these conditions by age 50 years.
CONCLUSIONS
Childhood cancer survivors exhibited similar or better cardiometabolic and lifestyle profiles compared with NHANES, but nonetheless are at risk for future clinically significant cardiovascular disease.
IMPACT
Further strategies supporting optimal CRF control are warranted in survivors. See related commentary by Mulrooney, p. 515.
背景
儿童癌症幸存者存在心血管疾病风险。我们评估了幸存者与人口匹配对照组相比，潜在可改变的心血管代谢危险因素（CRF）的负担。
方法
1996 年至 2001 年期间，曾参加儿科肿瘤组方案 9404、9425、9426、9754 和达纳法伯癌症研究所 95-01 的急性淋巴细胞白血病/淋巴瘤、霍奇金淋巴瘤或骨肉瘤幸存者，前瞻性评估了 CRF 的患病率，并与年龄、性别和种族/民族相匹配的 2013 年国家健康和营养检查调查（NHANES）人群进行了比较。我们根据一般人群（如弗雷明汉）和儿童癌症幸存者研究（CCSS）模型估计了未来的心血管风险预测。
结果
与 NHANES（n = 584）相比，幸存者[n = 164；44.5%为女性，中位年龄 28 岁（范围 16-38 岁）；中位癌症诊断后时间 17.4 年（范围 13-22 年）；中位多柔比星剂量 300mg/m2；30.5%胸部放疗]肥胖、糖尿病和血脂异常的发生率相似，但高血压前期/高血压的发生率更高（38.4% vs. 30.1%，P = 0.044）。与 NHANES 相比，幸存者的代谢综合征特征更少（≥2 个特征：26.7% vs. 55.9%；P < 0.001）。幸存者更活跃，吸烟较少（均 P < 0.0001）。因此，与 NHANES 相比，一般人群的心血管风险评分较低。然而，根据 CCSS 模型，30.5%的幸存者有中等风险发生缺血性心脏病，超过 95%的幸存者有发生心力衰竭的中高风险，50 岁时这些疾病的预测发病率为 9%至 12%。
结论
与 NHANES 相比，儿童癌症幸存者表现出相似或更好的心血管代谢和生活方式特征，但仍存在未来发生临床显著心血管疾病的风险。
影响
需要进一步采取策略支持幸存者控制心血管代谢危险因素。详见 Mulrooney 的相关评论，第 515 页。
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