Charrier Thibaud, Haddy Nadia, Schwartz Boris, Journy Neige, Fresneau Brice, Demoor-Goldschmidt Charlotte, Diallo Ibrahima, Surun Aurore, Aerts Isabelle, Doz François, Souchard Vincent, Vu-Bezin Giao, Laprie Anne, Lemler Sarah, Letort Véronique, Rubino Carole, Chounta Stéfania, de Vathaire Florent, Latouche Aurélien, Allodji Rodrigue S
Cancer and Radiation Team, Centre de Research en Epidemiologie et Santé des Populations, Université Paris-Saclay- Université Paris-Sud-Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, France.
Cancer and Radiation Team, Centre de Research en Epidemiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.
JACC CardioOncol. 2023 Oct 3;5(6):792-803. doi: 10.1016/j.jaccao.2023.07.008. eCollection 2023 Dec.
Childhood cancer survivors (CCS) are at an elevated risk of developing both a second malignant neoplasm (SMN) and cardiac disease.
This study sought to assess the excess of occurrence of cardiac disease after a SMN among CCS.
Analyses included 7,670 CCS from the French Childhood Cancer Survivors Study cohort diagnosed between 1945 and 2000. To account for the time dependence of the occurrence of a SMN, we employed a landmark approach, considering an additive regression model for the cumulative incidence of cardiac disease. We estimated the effect of a SMN on the instantaneous risk of cardiac disease using a proportional cause-specific hazard model, considering a SMN as a time-dependent exposure. In both models, we adjusted for demographic and treatment information and considered death as a competing event.
In 7,670 CCS over a median follow-up of 30 years (IQR: 22-38 years), there were 378 cases of cardiac disease identified, of which 49 patients experienced a SMN. Patients who survived 25 years after their childhood cancer diagnosis and had a SMN in that time frame had a significantly increased cumulative incidence of cardiac disease, which was 3.8% (95% CI: 0.5% to 7.1%) higher compared with those without a SMN during this period. No SMN-induced excess of cardiac disease was observed at subsequent landmark times. SMNs were associated with a 2-fold increase (cause-specific HR: 2.0; 95% CI: 1.4-2.8) of cardiac disease.
The occurrence of a SMN among CCS is associated with an increased risk of cardiac disease occurrence and risk at younger ages.
儿童癌症幸存者（CCS）发生第二种恶性肿瘤（SMN）和心脏病的风险有所升高。
本研究旨在评估CCS发生SMN后心脏病发生的额外风险。
分析纳入了来自法国儿童癌症幸存者研究队列的7670名CCS，这些患者于1945年至2000年间被诊断。为了考虑SMN发生的时间依赖性，我们采用了一种标志性方法，考虑使用心脏病累积发病率的加法回归模型。我们使用比例病因特异性风险模型估计SMN对心脏病瞬时风险的影响，将SMN视为时间依赖性暴露。在这两个模型中，我们对人口统计学和治疗信息进行了调整，并将死亡视为竞争事件。
在7670名CCS中，中位随访时间为30年（四分位间距：22 - 38年），共确定了378例心脏病病例，其中49例患者发生了SMN。在儿童癌症诊断后存活25年且在此期间发生SMN的患者，其心脏病累积发病率显著增加，与同期未发生SMN的患者相比，高出3.8%（95%置信区间：0.5%至7.1%）。在随后的标志性时间未观察到SMN引起的心脏病额外风险。SMN与心脏病风险增加两倍相关（病因特异性风险比：2.0；95%置信区间：1.4 - 2.8）。
CCS中SMN的发生与心脏病发生风险增加以及年轻时的风险增加相关。
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