Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
Minnesota Population Center, University of Minnesota, Minneapolis, Minnesota, USA.
Pediatr Blood Cancer. 2024 Dec;71(12):e31271. doi: 10.1002/pbc.31271. Epub 2024 Aug 13.
Children with congenital heart defects (CHD) have shorter life expectancy than the general population. Previous studies also suggest that patients with CHD have higher risk of cancer. This study aims to describe cancer-related mortality among patients with a history of CHD interventions using the Pediatric Cardiac Care Consortium (PCCC), a large US cohort of such patients.
We performed a retrospective cohort study of individuals (<21 years) who underwent interventions for CHD in the PCCC from 1982 to 2003. Patients surviving their first intervention were linked to the National Death Index through 2020. Multivariable models assessed risk of cancer-related death, adjusting for age, sex, race, and ethnicity. Patients with/without genetic abnormalities (mostly Down syndrome [DS]) were considered separately, due to expected differential risk in cancer.
Among the 57,601 eligible patients in this study, cancer was the underlying or contributing cause of death for 208; with 20% among those with DS. Significantly increased risk of cancer-related death was apparent among patients with DS compared to the non-genetic group (aHR: 3.63, 95% confidence interval [CI]: 2.52-5.24, p < .001). For the group with non-genetic abnormalities, the highest association with cancer-related death compared to those with mild CHD was found among those with more severe CHD (severe two-ventricle aHR: 1.82, 95% CI: 1.04-3.20, p = .036, single-ventricle aHR: 4.68, 95% CI: 2.77-7.91, p < .001).
Patients with more severe forms of CHD are at increased risk for cancer-related death. Despite our findings, we are unable to distinguish whether having CHD raises the risk of cancer or reduces survival.
患有先天性心脏病 (CHD) 的儿童预期寿命短于普通人群。先前的研究还表明，CHD 患者患癌症的风险更高。本研究旨在使用美国大型先天性心脏病患者队列——儿科心脏护理联合会 (PCCC)，描述曾接受过 CHD 干预治疗的患者的癌症相关死亡率。
我们对 1982 年至 2003 年期间在 PCCC 接受 CHD 干预治疗的个体（<21 岁）进行了回顾性队列研究。首次干预后存活的患者通过全国死亡索引与 2020 年进行了链接。多变量模型评估了癌症相关死亡的风险，调整了年龄、性别、种族和民族。由于癌症风险存在差异，分别考虑了有/无遗传异常（主要为唐氏综合征 [DS]）的患者。
在本研究的 57601 名合格患者中，有 208 人因癌症是死亡的根本或促成原因，其中 20%的患者患有 DS。与无遗传组相比，DS 患者的癌症相关死亡风险明显增加（调整后危险比 [aHR]：3.63，95%置信区间 [CI]：2.52-5.24，p<0.001）。对于无遗传异常的患者组，与轻度 CHD 患者相比，与癌症相关死亡关联度最高的是 CHD 更为严重的患者（严重双心室 aHR：1.82，95%CI：1.04-3.20，p=0.036，单心室 aHR：4.68，95%CI：2.77-7.91，p<0.001）。
CHD 更为严重的患者发生癌症相关死亡的风险增加。尽管我们的发现表明，我们无法区分是 CHD 增加了癌症风险还是降低了生存率。
