Kooijmans Esmee C M, Mulder Renée L, Marks Stephen D, Pavasovic Vesna, Motwani Shveta S, Walwyn Thomas, Larkins Nicholas G, Kruseova Jarmila, Constine Louis S, Wallace W Hamish, Green Daniel M, Bökenkamp Arend, van der Pal Helena J H, van den Heuvel-Eibrink Marry M, Hjorth Lars, Andrés-Jensen Liv, Bardi Edit, van Dalen Elvira C, Demoor-Goldschmidt Charlotte, Becktell Kerri, Grönroos Marika, Kieran Kathleen, Mironova Denitza, Terenziani Monica, Veening Margreet A, Zieg Jakub, Onder Songul, Onder Ali Mirza, Routh Jonathan C, Thompson Joel, Hudson Melissa M, Kremer Leontien C M, Skinner Roderick, Ehrhardt Matthew J
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
J Clin Oncol. 2025 May 20:JCO2402534. doi: 10.1200/JCO-24-02534.
Childhood, adolescent, and young adult (CAYA) survivors of cancer are at risk of nephrotoxicity. Surveillance guidelines are important for timely diagnosis and treatment of these survivors, which could slow the progression to higher stages of kidney dysfunction.
The International Late Effects of Childhood Cancer Guideline Harmonization Group established a multidisciplinary panel of 34 experts from 11 countries. The panel performed systematic literature reviews for articles published between 1990 and June 2023, graded the evidence using Grading of Recommendations Assessment, Development, and Evaluation methodology, and formulated recommendations based on evidence, clinical judgment, and consideration of benefits and harms of surveillance. Recommendations were critically appraised by two independent external experts and patient representatives.
Glomerular dysfunction surveillance is recommended every 2-5 years for survivors treated with ifosfamide, cisplatin, abdominal radiotherapy, total body irradiation, or nephrectomy and is reasonable after carboplatin treatment. We recommend screening for glomerular dysfunction using an estimated glomerular filtration rate (eGFR) equation that includes serum creatinine, preferably combined with serum cystatin C if available. Tubular dysfunction surveillance is recommended once at entry into long-term follow-up and with follow-up as clinically indicated for survivors treated with ifosfamide and is reasonable after cisplatin treatment.
These recommendations inform routine, uniform long-term follow-up care for CAYA survivors of cancer at risk of nephrotoxicity.
癌症儿童、青少年及青年（CAYA）幸存者存在肾毒性风险。监测指南对于这些幸存者的及时诊断和治疗很重要，这可能减缓肾功能障碍进展至更高阶段。
国际儿童癌症长期效应指南协调小组组建了一个由来自11个国家的34名专家组成的多学科小组。该小组对1990年至2023年6月发表的文章进行了系统的文献综述，采用推荐分级评估、制定和评价方法对证据进行分级，并根据证据、临床判断以及对监测利弊的考虑制定推荐意见。推荐意见由两名独立的外部专家和患者代表进行严格评估。
对于接受异环磷酰胺、顺铂、腹部放疗、全身照射或肾切除术治疗的幸存者，建议每2 - 5年进行一次肾小球功能障碍监测，在接受卡铂治疗后进行监测也是合理的。我们建议使用包含血清肌酐的估计肾小球滤过率（eGFR）方程筛查肾小球功能障碍，如有血清胱抑素C则最好将其与血清肌酐联合使用。对于接受异环磷酰胺治疗的幸存者，建议在进入长期随访时以及根据临床指征进行随访时各进行一次肾小管功能障碍监测，在接受顺铂治疗后进行监测也是合理的。
这些推荐意见为有肾毒性风险的癌症CAYA幸存者的常规、统一长期随访护理提供了依据。
