Myocardial infarction mortality risk after treatment for Hodgkin disease: A collaborative British cohort study
Myocardial infarction mortality risk after treatment for Hodgkin disease: A collaborative British cohort study
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DOI：
10.1093/jnci/djk029
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发表时间：
2007-02-07
期刊：
影响因子：
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通讯作者：
Linch, David C.
中科院分区：
文献类型：
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作者：
Swerdlow, Anthony J.;Higgins, Craig D.;Linch, David C.
背景心肌梗死是霍奇金病幸存者长期死亡率过高的主要原因，但关于用于治疗这些患者的特定化疗方案对心肌梗死死亡风险的影响的信息有限。方法我们随访了1967年11月1日至2000年9月30日在英国接受治疗的7033例霍奇金病患者，并将他们的心肌梗死死亡率风险与英格兰和威尔士的普通人群进行比较。所有的统计检验均为双侧。结果共166例心肌梗死死亡发生在队列中，统计学显著高于预期（标准化死亡率[SMR] = 2.5，95%置信区间[CI] = 2.1至2.9），绝对超额风险为125.8每10万人年。标准化死亡率随首次治疗时年龄的增大而急剧下降，但心肌梗死死亡的绝对超额风险随首次治疗时年龄的增大而增加，直至65岁。首次治疗后25年，心肌梗死死亡率的风险持续增加，具有统计学显著性。对于接受过膈上放疗、蒽环类药物或长春新碱治疗的患者，风险增加具有统计学显著性和独立性。接受多柔比星、博莱霉素、长春碱和达卡巴嗪方案治疗的患者风险尤其高（SMR = 9.5，95% CI = 3.5 - 20.6）。首次治疗后20年或更长时间的风险是特别大的患者谁接受了膈上放射治疗和长春新碱没有蒽环类药物（SMR = 14.8，95%CI = 4.8至34.5）。结论心肌梗死治疗后霍奇金病的死亡风险仍然很高，至少25年。增加的风险与膈上放射治疗有关，但也可能与蒽环类药物和长春新碱治疗有关。
Background Myocardial infarction is a major cause of excess long-term mortality in survivors of Hodgkin disease, but limited information exists on the effects of specific chemotherapy regimens used to treat these patients on their risk of death from myocardial infarction.Methods We followed a cohort of 7033 Hodgkin disease patients who were treated in Britain from November 1, 1967, through September 30, 2000, and compared their risk of myocardial infarction mortality with that in the general population of England and Wales. All statistical tests were two-sided.Results A total of 166 deaths from myocardial infarction occurred in the cohort, statistically significantly more than expected (standardized mortality ratio [SMR] = 2.5, 95% confidence interval [CI] = 2.1 to 2.9), with an absolute excess risk of 125.8 per 100000 person-years. Standardized mortality ratios decreased sharply with older age at first treatment, but absolute excess risks of death from myocardial infarction increased with older age up to age 65 years at first treatment. The statistically significantly increased risk of myocardial infarction mortality persisted through to 25 years after first treatment. Risks were increased statistically significantly and independently for patients who had been treated with supradiaphragmatic radiotherapy, anthracyclines, or vincristine. Risk was particularly high for patients treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine regimen (SMR = 9.5, 95% CI = 3.5 to 20.6). Risk at 20 or more years after first treatment was particularly great for patients who had received supradiaphragmatic radiotherapy and vincristine without anthracylines (SMR = 14.8, 95% CI = 4.8 to 34.5).Conclusions The risk of death from myocardial infarction after treatment for Hodgkin disease remains high for at least 25 years. The increased risks are related to supradiaphragmatic radiotherapy but may also be related to anthracycline and vincristine treatment.