Houtman Bente M, Walraven Iris, Kapusta Livia, Teske Arco J, van Dulmen-den Broeder Eline, Tissing Wim J E, van den Heuvel-Eibrink Marry M, Versluys A B Birgitta, Bresters Dorine, van der Heiden-van der Loo Margriet, Ronckers Cécile, Kok Wouter E M, van der Pal Helena J H, Pluijm Saskia M F, Janssens Geert O, Blijlevens Nicole M A, Kremer Leontien C M, Loonen Jacqueline J, Feijen E A M Lieke
Radboudumc Center of Expertise for Cancer Survivorship, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands.
Pediatr Blood Cancer. 2024 Nov;71(11):e31251. doi: 10.1002/pbc.31251. Epub 2024 Aug 12.
Splenectomy might be a risk factor for valvular heart disease (VHD) in adult Hodgkin lymphoma survivors. As this risk is still unclear for childhood cancer survivors (CCS), the aim of this study is to evaluate the association between treatments affecting splenic function (splenectomy and radiotherapy involving the spleen) and VHD in CCS.
CCS were enrolled from the DCCSS-LATER cohort, consisting of 6,165 five-year CCS diagnosed between 1963 and 2002. Symptomatic VHD, defined as symptoms combined with a diagnostic test indicating VHD, was assessed from questionnaires and validated using medical records. Differences in the cumulative incidence of VHD between CCS who received treatments affecting splenic function and CCS who did not were assessed using the Gray test. Risk factors were analyzed in a multivariable Cox proportional hazards model.
The study population consisted of 5,286 CCS, with a median follow-up of 22 years (5-50 years), of whom 59 (1.1%) had a splenectomy and 489 (9.2%) radiotherapy involving the spleen. VHD was present in 21 CCS (0.4%). The cumulative incidence of VHD at the age of 40 years was significantly higher in CCS who received treatments affecting splenic function (2.7%, 95% confidence interval (CI) 0.4%-4.9%) compared with CCS without (0.4%, 95% CI 0.1%-0.7%) (Gray's test, p = 0.003). Splenectomy was significantly associated with VHD in a multivariable analysis (hazard ratio 8.6, 95% CI 3.1-24.1).
Splenectomy was associated with VHD. Future research is needed to determine if CCS who had a splenectomy as part of cancer treatment might benefit from screening for VHD.
脾切除术可能是成年霍奇金淋巴瘤幸存者患心脏瓣膜病（VHD）的一个危险因素。由于儿童癌症幸存者（CCS）的这一风险仍不明确，本研究旨在评估影响脾脏功能的治疗（脾切除术和涉及脾脏的放疗）与CCS患VHD之间的关联。
从DCCSS-LATER队列中纳入CCS，该队列由1963年至2002年间确诊的6165名5年存活的CCS组成。有症状的VHD定义为症状加上表明VHD的诊断测试，通过问卷调查进行评估，并使用病历进行验证。使用Gray检验评估接受影响脾脏功能治疗的CCS与未接受此类治疗的CCS之间VHD累积发病率的差异。在多变量Cox比例风险模型中分析危险因素。
研究人群包括5286名CCS，中位随访时间为22年（5至50年），其中59人（1.1%）接受了脾切除术，489人（9.2%）接受了涉及脾脏的放疗。21名CCS（0.4%）患有VHD。接受影响脾脏功能治疗的CCS在40岁时VHD的累积发病率（2.7%，95%置信区间（CI）0.4%-4.9%）显著高于未接受此类治疗的CCS（0.4%，95%CI 0.1%-0.7%）（Gray检验，p = 0.003）。在多变量分析中，脾切除术与VHD显著相关（风险比8.6，95%CI 3.1-24.1）。
脾切除术与VHD相关。需要进一步研究以确定作为癌症治疗一部分接受脾切除术的CCS是否可能从VHD筛查中获益。
