Schuster Alexander K, Voigt Anna Maria, Jäger Tamara, Nickels Stefan, Schulz Andreas, Faber Jörg, Wingerter Arthur, Merzenich Hiltrud, Schmidtmann Irene, Beutel Manfred E, Münzel Thomas, Lackner Karl J, Pfeiffer Norbert, Wild Philipp S
Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Acta Ophthalmol. 2025 Jun;103(4):e231-e239. doi: 10.1111/aos.17438. Epub 2025 Jan 23.
Childhood cancer is a risk factor for cardiovascular diseases in later life. Retinal examination allows to non-invasively observe the vasculature of an end-organ. We observe alterations in long-term childhood cancer survivors (CCS).
In the Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer-Study, 1002 CCS (23-48 years) having neoplasia prior to 15 years of age were prospectively enrolled in a general and ophthalmologic examination including fundus photography. Central retinal vessel equivalents (arterial: CRAE; venous CRVE) were measured and linear regression analysis was computed to compare CCS to controls from the population-based Gutenberg Health Study (GHS) with adjustment for potential cardiovascular and ophthalmological confounders. Differences in cancer types and treatments were explored.
For 837 CCS (45.3% female), CRAE and CRVE were conducted. Both were smaller in CCS previously having leukaemia, central nervous system tumour, neuroblastoma, renal tumour, malignant bone tumour, soft tissue sarcoma and germ cell tumour than in GHS controls. No difference was found for CCS with prior lymphoma. Previous radiotherapy of head or neck was associated with a smaller CRVE. Higher mean arterial blood pressure and intake of antihypertensive medication were associated with smaller CRAE.
Retinal vasculature is altered in CCS leading to smaller retinal arteries and veins. Our finding indicates that childhood cancer and its treatment leads to systemic alterations of the microcirculation on both branches of the vasculature system. While the retinal venous vasculature is altered by radiotherapy, the lower vessel width of the arterial branch is associated with arterial hypertension.
儿童癌症是日后发生心血管疾病的一个风险因素。视网膜检查可用于非侵入性观察终末器官的血管系统。我们观察长期儿童癌症幸存者（CCS）的血管变化。
在儿童癌症长期幸存者的心脏和血管晚期后遗症研究中，前瞻性纳入了1002名在15岁之前患有肿瘤的CCS（23 - 48岁），进行包括眼底摄影在内的全身和眼科检查。测量视网膜中央血管等效值（动脉：CRAE；静脉：CRVE），并进行线性回归分析，将CCS与基于人群的古登堡健康研究（GHS）中的对照组进行比较，同时对潜在的心血管和眼科混杂因素进行校正。探讨癌症类型和治疗方法的差异。
对837名CCS（45.3%为女性）进行了CRAE和CRVE测量。既往患有白血病、中枢神经系统肿瘤、神经母细胞瘤、肾肿瘤、恶性骨肿瘤、软组织肉瘤和生殖细胞肿瘤的CCS，其CRAE和CRVE均小于GHS对照组。既往患有淋巴瘤的CCS未发现差异。既往头颈部放疗与较小的CRVE相关。较高的平均动脉血压和服用抗高血压药物与较小的CRAE相关。
CCS的视网膜血管系统发生改变，导致视网膜动静脉变窄。我们的研究结果表明，儿童癌症及其治疗会导致血管系统两个分支的微循环发生全身性改变。虽然视网膜静脉血管系统因放疗而改变，但动脉分支较窄的血管宽度与动脉高血压有关。
