Bolier Melissa, de Winter Demi T C, Pluimakers Vincent G, Fiocco Marta, van den Berg Sjoerd A A, Bresters Dorine, van Dulmen-den Broeder Eline, van der Heiden-van der Loo Margriet, Höfer Imo, Janssens Geert O, Kremer Leontien C M, Loonen Jacqueline J, Louwerens Marloes, van der Pal Heleen J, Pluijm Saskia M F, Tissing Wim J E, van Santen Hanneke M, de Vries Andrica C H, van der Lely Aart-Jan, van den Heuvel-Eibrink Marry M, Neggers Sebastian J C M M
Department of Internal Medicine, Endocrinology Section, Erasmus Medical Center, Rotterdam, The Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Cancer. 2025 Jan 1;131(1):e35681. doi: 10.1002/cncr.35681.
Because the occurrence of metabolic syndrome (MetS) might contribute to childhood cancer survivor's excess risk of cardiovascular disease, the authors assessed the prevalence and determinants of MetS in the Dutch Childhood Cancer Survivor Study (DCCSS-LATER2) cohort.
In total, 2338 adult childhood cancer survivors (CCS) were cross-sectionally assessed for the prevalence of MetS, using the Lifelines cohort (N = 132,226 adults without a history of cancer) as references. The prevalence of MetS was clinically assessed using existing classifications, as well as an alternative method using dual-energy x-ray absorptiometry fat% instead of waist circumference to define abdominal adiposity. Logistic regression models, adjusted for age and sex, were used to investigate the association between the presence of MetS and both cohorts. Demographic, lifestyle, and treatment determinants of MetS were identified through multivariable logistic regression.
The survivor cohort (median age, 34.7 years, median follow-up time, 27.1 years) showed increased adjusted odds ratio (aOR) for MetS (modified National Cholesterol Education Program Adult Treatment Panel III criteria), as compared to the reference cohort (aOR, 2.07; 95% confidence interval [CI], 1.85-2.32). Compared to these criteria, the alternative method identified 57 additional survivors with MetS (395 of 2070 [19.1%] vs. 452 of 1960 [23.1%], respectively). Age (odds ratio [OR], 1.07; 95% CI, 1.04-1.10, per year increase), smoking (OR, 1.46; 95% CI, 1.04-2.04), low physical activity (OR, 1.48; 95% CI, 1.05-2.09), abdominal radiotherapy (OR, 2.13; 95% CI, 1.01-4.31; >30 Gy), cranial radiotherapy (OR, 2.89; 95% CI, 1.67-4.96; 1-25 Gy; and OR, 2.44; 95% CI, 1.30-4.47; >25 Gy), total body irradiation (OR, 6.17; 95% CI, 3.20-11.76), and underlying central nervous system tumor (OR, 1.78; 95% CI, 1.21-2.60) were associated with MetS.
The high risk of MetS in CCS, combined with several potential modifiable factors, underscores the need for timely identification and intervention strategies to mitigate the long-term cardiovascular risks in CCS.
由于代谢综合征（MetS）的发生可能导致儿童癌症幸存者患心血管疾病的风险增加，作者在荷兰儿童癌症幸存者研究（DCCSS-LATER2）队列中评估了MetS的患病率及其决定因素。
总共对2338名成年期儿童癌症幸存者（CCS）进行了横断面评估，以确定MetS的患病率，并以生命线队列（N = 132,226名无癌症病史的成年人）作为对照。使用现有分类方法以及一种替代方法对MetS的患病率进行临床评估，替代方法使用双能X线吸收法测定的脂肪百分比而非腰围来定义腹部肥胖。采用经年龄和性别调整的逻辑回归模型，研究MetS的存在与两个队列之间的关联。通过多变量逻辑回归确定MetS的人口统计学、生活方式和治疗决定因素。
与对照队列相比，幸存者队列（中位年龄34.7岁，中位随访时间27.1年）经调整后的MetS优势比（aOR）升高（采用美国国家胆固醇教育计划成人治疗小组第三次报告标准，aOR为2.07；95%置信区间[CI]为1.85 - 2.32）。与这些标准相比，替代方法多识别出57名患有MetS的幸存者（分别为2070名中的395名[19.1%]和1960名中的452名[23.1%]）。年龄（优势比[OR]为1.07；95%CI为1.04 - 1.10，每年增加）、吸烟（OR为1.46；95%CI为1.04 - 2.04）、低体力活动（OR为1.48；95%CI为1.05 - 2.09）、腹部放疗（OR为2.13；95%CI为1.01 - 4.31；>30 Gy）、颅脑放疗（OR为2.89；95%CI为1.67 - 4.96；1 - 25 Gy；以及OR为2.44；95%CI为1.30 - 4.47；>25 Gy）、全身照射（OR为6.17；95%CI为3.20 - 11.76）和潜在的中枢神经系统肿瘤（OR为1.78；95%CI为1.21 - 2.60）均与MetS相关。
CCS中MetS的高风险，以及几个潜在的可改变因素，强调了及时识别和采取干预策略以减轻CCS长期心血管风险的必要性。
