ECOG-ACRIN E2805 研究中血管内皮生长因子抑制对青少年/年轻成人的心血管影响。
Cardiovascular Implications of Vascular Endothelial Growth Factor Inhibition Among Adolescents/Young Adults in ECOG-ACRIN E2805.
机构信息
Division of Cardiovascular Medicine, Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
Department of Data Science/ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
出版信息
J Natl Compr Canc Netw. 2023 Jul;21(7):725-731.e1. doi: 10.6004/jnccn.2023.7018.
BACKGROUND
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among adolescents and young adults (AYAs) diagnosed with cancer. The aim of this study was to assess the incidence and predictors of left ventricular systolic dysfunction (LVSD) and hypertension among AYAs receiving VEGF inhibition compared with non-AYAs.
METHODS
This retrospective analysis used data from the ASSURE trial (ClinicalTrials.gov identifier: NCT00326898), in which participants with nonmetastatic, high-risk, renal cell cancer were randomized to sunitinib, sorafenib, or placebo. The incidence of LVSD (left ventricular ejection fraction decrease >15%) and hypertension (blood pressure ≥140/90 mm Hg) were compared using nonparametric tests. Multivariable logistic regression examined the association between AYA status, LVSD, and hypertension while adjusting for clinical factors.
RESULTS
AYAs represented 7% (103/1,572) of the population. Over a study treatment period of 54 weeks, the incidence of LVSD was not significantly different among AYAs (3%; 95% CI, 0.6%-8.3%) versus non-AYAs (2%; 95% CI, 1.2%-2.7%). The incidence of hypertension was significantly lower among AYAs (18%; 95% CI, 7.5%-33.5%) compared with non-AYAs (46%; 95% CI, 41.9%-50.4%) in the placebo arm. In the sunitinib and sorafenib groups, the incidence of hypertension for AYAs compared with non-AYAs was 29% (95% CI, 15.1%-47.5%) versus 47% (95% CI, 42.3%-51.7%), and 54% (95% CI, 33.9%-72.5%) versus 63% (95% CI, 58.6%-67.7%), respectively. AYA status (odds ratio, 0.48; 95% CI, 0.31-0.75) and female sex (odds ratio, 0.74; 95% CI, 0.59-0.92) were each associated with a lower risk of hypertension.
CONCLUSIONS
LVSD and hypertension were prevalent among AYAs. CVD among AYAs is only partially explained by cancer therapy. Understanding CVD risk among AYA cancer survivors is important for promoting cardiovascular health in this growing population.
背景
心血管疾病（CVD）是患有癌症的青少年和年轻人（AYA）发病和死亡的主要原因。本研究旨在评估与非 AYA 相比，接受 VEGF 抑制剂治疗的 AYA 中左心室收缩功能障碍（LVSD）和高血压的发生率和预测因素。
方法
本回顾性分析使用了 ASSURE 试验（ClinicalTrials.gov 标识符：NCT00326898）的数据，其中患有非转移性、高危、肾细胞癌的参与者被随机分配接受舒尼替尼、索拉非尼或安慰剂治疗。使用非参数检验比较 LVSD（左心室射血分数下降>15%）和高血压（血压≥140/90mmHg）的发生率。多变量逻辑回归在调整临床因素的情况下，检查 AYA 状态、LVSD 和高血压之间的关联。
结果
AYA 占人群的 7%（103/1572）。在 54 周的研究治疗期间，AYA 与非 AYA 相比，LVSD 的发生率无显著差异（3%；95%CI，0.6%-8.3%）（2%；95%CI，1.2%-2.7%）。在安慰剂组中，AYA 中高血压的发生率明显低于非 AYA（18%；95%CI，7.5%-33.5%）（46%；95%CI，41.9%-50.4%）。与非 AYA 相比，舒尼替尼和索拉非尼组中 AYA 的高血压发生率分别为 29%（95%CI，15.1%-47.5%）和 47%（95%CI，42.3%-51.7%），54%（95%CI，33.9%-72.5%）和 63%（95%CI，58.6%-67.7%）。AYA 状态（比值比，0.48；95%CI，0.31-0.75）和女性（比值比，0.74；95%CI，0.59-0.92）与高血压风险降低相关。
结论
LVSD 和高血压在 AYA 中很常见。AYA 的 CVD 部分原因是癌症治疗引起的。了解 AYA 癌症幸存者的 CVD 风险对于促进这一不断增长人群的心血管健康非常重要。
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