Bryce Yolanda, Whitton Jillian A, Stratton Kayla L, Leisenring Wendy M, Chow Eric J, Armstrong Gregory, Weil Brent, Dieffenbach Bryan, Howell Rebecca M, Oeffinger Kevin C, Nathan Paul C, Tonorezos Emily S
Memorial Sloan Kettering, New York, New York, USA.
Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Cancer. 2025 Jan 1;131(1):e35591. doi: 10.1002/cncr.35591. Epub 2024 Oct 10.
Many childhood cancer survivors are at risk for cardiovascular disease and stroke. The North American Children's Oncology Group long-term follow-up guidelines recommend carotid ultrasound in cancer survivors 10 years after neck radiation therapy (RT) ≥40 Gy. The use of carotid ultrasound in this population has not been described.
Survivors of childhood cancer diagnosed 1970-1999 (N = 8693) and siblings (N = 1989) enrolled in the Childhood Cancer Survivor Study were asked if they had ever had a carotid ultrasound. Prevalence of carotid ultrasound was evaluated. Prevalence ratios (PR) and 95% confidence intervals (CIs) were evaluated in multivariate Poisson regression models.
Among participants with no reported cardiovascular condition, prevalence of carotid ultrasound among survivors with RT ≥40 Gy to the neck (N = 172) was 29.7% (95% CI, 22.5-36.8), significantly higher than those with <40 Gy (prevalence 10.7%; 95% CI, 9.9%-11.4%). Siblings without a cardiovascular condition (N = 1621) had the lowest prevalence of carotid ultrasound (4.7%; 95% CI, 3.6%-5.7%). In a multivariable models among survivors with no reported cardiovascular condition and RT ≥40 Gy to the neck, those who were over age 50 (vs. 18-49) at follow-up (PR = 1.82; 95% CI, 1.09-3.05), with a history of seeing a cancer specialist in the last 2 years (PR = 2.58; 95% CI, 1.53-4.33), or having a colonoscopy (PR = 2.02; 95% CI, 1.17-3.48) or echocardiogram (PR = 6.42; 95% CI, 1.54-26.85) were more likely to have had a carotid ultrasound.
Many survivors do not undergo carotid ultrasound despite meeting existing guidelines. Health care delivery features such as having seen a cancer specialist or having other testing are relevant.
许多儿童癌症幸存者面临心血管疾病和中风的风险。北美儿童肿瘤学组的长期随访指南建议，接受颈部放射治疗（RT）≥40 Gy的癌症幸存者在放疗10年后进行颈动脉超声检查。目前尚未对该人群中颈动脉超声的使用情况进行描述。
纳入儿童癌症幸存者研究的1970 - 1999年确诊的儿童癌症幸存者（N = 8693）和兄弟姐妹（N = 1989）被问及是否曾进行过颈动脉超声检查。评估颈动脉超声检查的患病率。在多变量泊松回归模型中评估患病率比（PR）和95%置信区间（CI）。
在未报告有心血管疾病的参与者中，颈部接受≥40 Gy放疗的幸存者（N = 172）中颈动脉超声检查的患病率为29.7%（95% CI，22.5 - 36.8），显著高于接受<40 Gy放疗的幸存者（患病率10.7%；95% CI，9.9% - 11.4%）。无心血管疾病的兄弟姐妹（N = 1621）颈动脉超声检查的患病率最低（4.7%；95% CI，3.6% - 5.7%）。在未报告有心血管疾病且颈部接受≥40 Gy放疗的幸存者的多变量模型中，随访时年龄超过50岁（vs. 18 - 49岁）者（PR = 1.82；95% CI，1.09 - 3.05）、过去2年内有看癌症专科医生史者（PR = 2.58；95% CI，1.53 - 4.33）、进行过结肠镜检查者（PR = 2.02；95% CI，1.17 - 3.48）或超声心动图检查者（PR = 6.42；95% CI，1.54 - 26.85）更有可能进行过颈动脉超声检查。
尽管符合现有指南，但许多幸存者并未接受颈动脉超声检查。诸如看过癌症专科医生或进行过其他检查等医疗服务提供特征与之相关。
