Risk of Cancer Among Children and Young Adults With Congenital Heart Disease Compared With Healthy Controls
Risk of Cancer Among Children and Young Adults With Congenital Heart Disease Compared With Healthy Controls
复制标题
DOI：
10.1001/jamanetworkopen.2019.6762
复制
发表时间：
2019-07-01
影响因子：
13.8
通讯作者：
Dellborg, Mikael
中科院分区：
文献类型：
--
作者：
Mandalenakis, Zacharias;Karazisi, Christina;Dellborg, Mikael
重要性 患有先天性心脏病 (CHD) 的成年患者癌症发病率增加，可能是由于重复的辐射暴露、遗传倾向或心脏干预期间重复的应激因素所致。然而，与一般人群相比，关于患有先心病的儿童和年轻人患癌症的风险的数据有限。 目的 与健康匹配对照相比，确定先心病患者从出生到 41 岁患癌症的风险。 设计、设置和参与者 这项在瑞典进行的基于登记的匹配前瞻性队列研究使用了患者和死因登记处的数据。确定了出生于 1970 年至 1979 年、1980 年至 1989 年和 1990 年至 1993 年的连续 CHD 患者队列。将每位患者 (n = 21 982) 的出生年份、性别和县与来自一般人群 (n = 219 816) 的 10 名无 CHD 的对照进行匹配。收集了 1970 年至 2011 年期间的随访和合并症数据。数据分析于 2018 年 9 月开始，于 2019 年 2 月结束。 主要结果和措施 患有 CHD 的儿童和年轻人以及健康对照者的癌症风险。 结果 在 21 982 名 CHD 患者和 219 816 名健康匹配对照者中，428 名 CHD 患者（2.0%）和2072 名对照者 (0.9%) 罹患癌症。在 CHD 患者中，随访时的平均 (SD) 年龄为 26.6 (8.4) 岁，11332 名参与者 (51.6%) 为男性。在健康对照中，随访时的平均 (SD) 年龄为 28.5 (9.1) 岁，113 319 名参与者 (51.6%) 为男性。到 41 岁时，每 50 名先心病患者中就有 1 人患上癌症。与对照组相比，患有 CHD 的儿童和年轻人的癌症总体风险比 (HR) 为 2.24 (95% CI，2.01-2.48)。 1990 年至 1993 年出生的人群中，每个连续出生队列的风险均增加至 3.37（95% CI，2.60-4.35）。患有 CHD 的男性和女性患癌症的风险相似（男性：HR，2.41；95% CI，2.08-2.79；女性：HR，2.08；95% CI， 1.80-2.41）。与对照组相比，接受手术的先心病患者的癌症 HR 为 1.95（95% CI，1.58-2.33）；对于未接受手术的先心病患者，HR 为 2.43（95% CI，2.12-2.76）。根据分层分类，与健康对照相比，患有复杂心脏病变（例如圆锥干缺陷）的患者患癌症的风险显着增加（HR，2.29；95% CI，1.62-3.25）。结论和相关性与健康匹配对照相比，患有 CHD 的儿童和青年患者患癌症的风险增加，并且最近出生队列中的 CHD 患者的风险显着更高。研究发现，所有先心病病变组患癌症的风险均增加，可以考虑对这一高危患者组进行系统的癌症筛查。
IMPORTANCE Adult patients with congenital heart disease (CHD) have an increased incidence of cancer, presumably owing to repeated radiation exposure, genetic predisposition, or repeated stress factors during heart interventions. However, there are limited data on the risk of cancer in children and young adults with CHD compared with the general population.OBJECTIVE To determine the risk of developing cancer from birth to age 41 years among patients with CHD compared with healthy matched controls.DESIGN, SETTING, AND PARTICIPANTS This registry-based, matched, prospective cohort study in Sweden used data from the Patient and Cause of Death Registers. Successive cohorts of patients with CHD born from 1970 to 1979, 1980 to 1989, and 1990 to 1993 were identified. Each patient (n = 21 982) was matched for birth year, sex, and county with 10 controls without CHD from the general population (n = 219 816). Follow-up and comorbidity data were collected from 1970 until 2011. Data analysis began in September 2018 and concluded in February 2019.MAIN OUTCOMES AND MEASURES Risk of cancer among children and young adults with CHD and among healthy controls.RESULTS Among 21 982 individuals with CHD and 219 816 healthy matched controls, 428 patients with CHD (2.0%) and 2072 controls (0.9%) developed cancer. Among patients with CHD, the mean (SD) age at follow-up was 26.6 (8.4) years, and 11332 participants (51.6%) were men. Among healthy controls, the mean (SD) age at follow-up was 28.5 (9.1) years, and 113 319 participants (51.6%) were men. By the age of 41 years, 1 of 50 patients with CHD developed cancer. The overall hazard ratio (HR) for cancer was 2.24 (95% CI, 2.01-2.48) in children and young adults with CHD compared with controls. Risk increased by each successive birth cohort to an HR of 3.37 (95% CI, 2.60-4.35) among those born from 1990 to 1993. The risk of cancer was similar in men and women with CHD (men: HR, 2.41; 95% CI, 2.08-2.79; women: HR, 2.08; 95% CI, 1.80-2.41). The HR for cancer among patients with CHD who underwent surgery was 1.95 (95% CI, 1.58-2.33) compared with controls; for patients with CHD who had not undergone surgery, the HR was 2.43 (95% CI, 2.12-2.76). According to a hierarchical classification, a significantly increased risk of cancer was found among patients with complex heart lesions, such as conotruncal defects (HR, 2.29; 95% CI, 1.62-3.25), compared with healthy controls.CONCLUSIONS AND RELEVANCE Children and young adult patients with CHD had an increased risk of developing cancer compared with healthy matched controls, and the risk was significantly higher among patients with CHD from the most recent birth cohort. An increased risk of cancer in all CHD lesion groups was found, and a systematic screening for cancer could be considered for this at-risk group of patients.