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1970-1999年间儿童癌症成年幸存者的主要心脏事件分析
作者:小柯机器人 发布时间:2020/1/19 16:40:41

美国圣裘德儿童研究医院Daniel A Mulrooney研究组近日取得一项新成果。他们分析了1970年至1999年确诊的儿童癌症成年幸存者的主要心脏事件。该研究成果于2020年1月15日发表于《英国医学杂志》。

当代癌症方案修订版将心脏毒性治疗暴露降至最低并保持长期健康,为了研究该修订方案对儿童癌症成年幸存者的严重心脏预后的影响,研究组设计了一项回顾性队列研究,在27家机构对儿童癌症幸存者进行研究。

研究组招募了1970年1月1日至1999年12月31日在21岁前被诊断为白血病、脑癌、霍奇金淋巴瘤、非霍奇金淋巴瘤、肾脏肿瘤、神经母细胞瘤、软组织肉瘤和骨肉瘤的患者23462例,确诊时的中位年龄为6.1岁,随访时的中位年龄为27.7岁。5057名癌症幸存者的兄弟姐妹作为对照组。

20世纪70年代治疗的患者心力衰竭的20年累积发病率为0.69%,80年代治疗者为0.74%,90年代治疗者0.54%,三个年代冠状动脉疾病发病率分别为0.38%、0.24%和0.19%,发病率在较近的时期均显著下降;而瓣膜疾病分别为0.06%、0.06%和0.05%,心包疾病分别为0.04%、0.02%和0.03%,心律失常分别为0.08%、0.09%和0.13%,发病率在较近时期则没有显著下降。

与70年代确诊的幸存者相比,80年代和90年代幸存者的心力衰竭、冠心病和瓣膜性心脏病的风险均有所降低,但仅冠心病风险降低有统计学意义。通过调整心脏辐射,冠状动脉疾病的总体风险有所降低,在霍奇金淋巴瘤中尤为明显。

总之,在儿童癌症的成年幸存者中,心脏辐射暴露的历史性减少降低了冠状动脉疾病的风险。

附:英文原文

Title: Major cardiac events for adult survivors of childhood cancer diagnosed between 1970 and 1999: report from the Childhood Cancer Survivor Study cohort

Author: Daniel A Mulrooney, Geehong Hyun, Kirsten K Ness, Matthew J Ehrhardt, Yutaka Yasui, Daniel Duprez, Rebecca M Howell, Wendy M Leisenring, Louis S Constine, Emily Tonorezos, Todd M Gibson, Leslie L Robison, Kevin C Oeffinger, Melissa M Hudson, Gregory T Armstrong

Issue&Volume: 2020/01/15

Abstract: 

Objective To investigate the impact of modifications to contemporary cancer protocols, which minimize exposures to cardiotoxic treatments and preserve long term health, on serious cardiac outcomes among adult survivors of childhood cancer.

Design Retrospective cohort study.

Setting 27 institutions participating in the Childhood Cancer Survivor Study.

Participants 23 462 five year survivors (6193 (26.4%) treated in the 1970s, 9363 (39.9%) treated in the 1980s, and 7906 (33.6%) treated in the 1990s) of leukemia, brain cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, renal tumors, neuroblastoma, soft tissue sarcomas, and bone sarcomas diagnosed prior to age 21 years between 1 January 1970 and 31 December 1999. Median age at diagnosis was 6.1 years (range 0-20.9) and 27.7 years (8.2-58.3) at last follow-up. A comparison group of 5057 siblings of cancer survivors were also included.

Main outcome measures Cumulative incidence and 95% confidence intervals of reported heart failure, coronary artery disease, valvular heart disease, pericardial disease, and arrhythmias by treatment decade. Events were graded according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events. Multivariable subdistribution hazard models were used to estimate hazard ratios by decade, and mediation analysis examined risks with and without exposure to cardiotoxic treatments.

Results The 20 year cumulative incidence of heart failure (0.69% for those treated in the 1970s, 0.74% for those treated in the 1980s, 0.54% for those treated in the 1990s) and coronary artery disease (0.38%, 0.24%, 0.19%, respectively), decreased in more recent eras (P<0.01), though not for valvular disease (0.06%, 0.06%, 0.05%), pericardial disease (0.04%, 0.02%, 0.03%), or arrhythmias (0.08%, 0.09%, 0.13%). Compared with survivors with a diagnosis in the 1970s, the risk of heart failure, coronary artery disease, and valvular heart disease decreased in the 1980s and 1990s but only significantly for coronary artery disease (hazard ratio 0.65, 95% confidence interval 0.45 to 0.92 and 0.53, 0.36 to 0.77, respectively). The overall risk of coronary artery disease was attenuated by adjustment for cardiac radiation (0.90, 0.78 to 1.05), particularly among survivors of Hodgkin lymphoma (unadjusted for radiation: 0.77, 0.66 to 0.89; adjusted for radiation: 0.87, 0.69 to 1.10).

Conclusions Historical reductions in exposure to cardiac radiation have been associated with a reduced risk of coronary artery disease among adult survivors of childhood cancer. Additional follow-up is needed to investigate risk reductions for other cardiac outcomes.

DOI: 10.1136/bmj.l6794

Source: https://www.bmj.com/content/368/bmj.l6794

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj