儿童、青少年和青年癌症幸存者的代谢综合征：国际儿童癌症长期效应指南协调小组的监测建议
Metabolic syndrome in childhood, adolescent, and young adult cancer survivors: recommendations for surveillance from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
作者信息
van den Oever Selina R, Mulder Renée L, Oeffinger Kevin C, Gietema Jourik A, Skinner Roderick, Constine Louis S, Wallace W Hamish, Armenian Saro, Barnea Dana, Bardi Edit, Belle Fabiën N, Brown Austin L, Chemaitilly Wassim, Crowne Liz, van Dalen Elvira C, Denzer Christian, Ehrhardt Matthew J, Felicetti Francesco, Friedman Danielle N, Fulbright Joy, Glaser Adam W, Giwercman Aleksander, Sangstuen Haugnes Hege, Hayek Samah, Hennewig Ulrike, van den Heuvel-Eibrink Marry M, Haupt Riccardo, van Iersel Laura, Kamdar Kala, Lefrandt Joop, Levitt Gill, Morsellino Vera, Mulrooney Daniel A, Murray Robert D, Neggers Sebastian, Ness Kirsten K, Neville Kristen A, Nock Nora L, Otth Maria, Prasad Pinki K, van Santen Hanneke M, Schindera Christina, Rath Shoshana R, Steinberger Julia, Terenziani Monica, Varedi Mitra, Walwyn Thomas, Wei Christina, Hudson Melissa M, Kremer Leontien C M, Nuver Janine, Tonorezos Emily
机构信息
Research Department, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands.
Department of Medicine, Duke School of Medicine/Duke Cancer Institute, 2400 Erwin Dr, Durham, NC 27705, United States.
出版信息
Eur J Endocrinol. 2025 Mar 27;192(4):S27-S40. doi: 10.1093/ejendo/lvaf046.
OBJECTIVE
Survivors of childhood, adolescent, and young adult (CAYA) cancer have an increased risk of metabolic syndrome (MetS). MetS describes the clustering of cardiovascular risk factors including overweight or obesity, hypertension, (pre)diabetes, and dyslipidaemia. While associated cardiovascular sequelae can be serious, MetS is preventable, manageable, and potentially reversible with the appropriate pharmacological and/or behavioral interventions. To optimize health outcomes in CAYA cancer survivors, international, harmonized surveillance recommendations are essential.
DESIGN
Systematic review and guideline development.
METHODS
A multidisciplinary guideline panel evaluated concordances and discordances across national guidelines for MetS surveillance and performed a systematic literature review. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and formulate recommendations considering the strength of the underlying evidence as well as potential harms and benefits associated with MetS surveillance. In case evidence was lacking, recommendations were based on expert opinion. In addition, recommendations for surveillance modalities were derived from existing guidelines for MetS components where applicable.
RESULTS
The systematic literature review included 20 studies and highlighted 2 high-risk groups, namely CAYA cancer survivors treated with total body irradiation and those treated with cranial or craniospinal irradiation (moderate-quality evidence). Recommendations were formulated for MetS surveillance in these risk groups, covering preferred screening modalities, age at screening initiation, and surveillance frequency.
CONCLUSIONS
In this international surveillance guideline for MetS in CAYA cancer survivors, we provide evidence-based recommendations for clinical practice, with the aim of ensuring optimal MetS surveillance for CAYA cancer survivors.
目的
儿童、青少年及青年（CAYA）癌症幸存者患代谢综合征（MetS）的风险增加。代谢综合征描述了包括超重或肥胖、高血压、（前期）糖尿病和血脂异常在内的心血管危险因素的聚集。虽然相关的心血管后遗症可能很严重，但通过适当的药物和/或行为干预，代谢综合征是可预防、可管理且可能逆转的。为了优化CAYA癌症幸存者的健康结局，国际统一的监测建议至关重要。
设计
系统评价和指南制定。
方法
一个多学科指南小组评估了各国代谢综合征监测指南之间的一致性和不一致性，并进行了系统的文献综述。采用推荐分级评估、制定和评价方法对现有证据进行分级，并根据基础证据的强度以及与代谢综合征监测相关的潜在危害和益处制定推荐意见。如果缺乏证据，则根据专家意见提出建议。此外，在适用的情况下，监测方式的建议来自于代谢综合征各组成部分的现有指南。
结果
系统文献综述纳入了20项研究，突出了2个高危组，即接受全身照射的CAYA癌症幸存者和接受颅脑或颅脊柱照射的幸存者（中等质量证据）。针对这些风险组的代谢综合征监测制定了建议，包括首选的筛查方式、开始筛查的年龄和监测频率。
结论
在本针对CAYA癌症幸存者代谢综合征的国际监测指南中，我们为临床实践提供了循证建议，旨在确保对CAYA癌症幸存者进行最佳的代谢综合征监测。
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