CARDIAC-FUNCTION IN WILMS-TUMOR SURVIVORS
CARDIAC-FUNCTION IN WILMS-TUMOR SURVIVORS
复制标题
DOI：
10.1200/jco.1995.13.7.1546
复制
发表时间：
1995-07-01
影响因子：
45.3
通讯作者：
SULLIVAN, I
中科院分区：
文献类型：
--
作者：
SORENSEN, K;LEVITT, G;SULLIVAN, I
目的：研究单一诊断组的晚期心功能（肾母细胞瘤儿童）具有良好的长期生存率;比较蒽环类药物治疗的患者（多柔比星）与未经蒽环类药物治疗的患者和正常儿童/青少年组的比较;并检查涉及晚期心功能不全的危险因素。对97例用蒽环类药物治疗的肾母细胞瘤患者进行超声心动图检查（平均累积剂量，303 mg/m2），平均随访时间为7.1年，39例未接受蒽环类药物治疗的肾母细胞瘤患者，平均随访时间为8.9年，50例正常受试者。比较两组的左心室（LV）尺寸、收缩末期室壁应力（后负荷的测量）以及负荷依赖性和非依赖性收缩力测量。潜在的危险因素，包括诊断时的年龄，随访时间，性别，青春期的状态，心脏照射，剂量强度，和蒽环类药物的累积剂量，进行了多变量analysis.Results：25%的蒽环类药物治疗组显示心脏异常。除1例患者外，所有患者的左心室后负荷均增加。后负荷增加的危险因素是蒽环类药物累积剂量（P <0.05）和蒽环类药物剂量强度（P <0.02）。与正常受试者相比，未接受蒽环类药物治疗的肾母细胞瘤患者左室壁增厚（P <0.05）。结论：蒽环类药物的总剂量和剂量强度是标准方案治疗的肾母细胞瘤长期存活者左室后负荷增加的危险因素。后负荷的增加导致左室缩短减少，而收缩力很少异常。未接受蒽环类药物治疗的肾母细胞瘤存活者有轻度左心室肥大的新发现可能对蒽环类药物诱导的心脏毒性作用提供一些保护。(C)1995年，美国临床肿瘤学会。
Purpose: To study late cardiac function in a single diagnostic group (children with Wilms' tumor) with good long-term survival; to compare patients treated with anthracyclines (doxorubicin) with patients treated without anthracyclines and with a normal child/adolescent group; and to examine the risk factors involved in late cardiac dysfunction.Patients and Methods: Echocordiographic studies were performed on 97 Wilms' tumor patients treated with anthracyclines (mean cumulative dose, 303 mg/m(2)) with a mean follow-up time of 7.1 years, on 39 Wilms' tumor patients treated without anthracyclines with a mean follow-up time of 8.9 years, and on 50 normal subjects. Left ventricular (LV) dimensions, end systolic wall stress (a measure of afterload), and load-dependent and -independent measures of contractility were compared between groups. Potential risk factors, including age at diagnosis, follow-up duration, sex, pubertal status, cardiac irradiation, dose-intensity, and cumulative dose of anthracyclines, were studied by multivariate analysis.Results: Twenty-five percent of the anthracycline-treated group showed cardiac abnormalities. All but one of these patients had increased LV afterload. Risk factors for increased afterload were anthracycline cumulative dose (P < .05) and anthracycline dose intensity (P < .02). Wilms' tumor patients treated without anthracyclines had thickened LV walls compared with normal subjects (P < .05).Conclusion: Total dose and dose-intensity of anthracycline were risk factors for increased LV afterload in long-term Wilms' tumor survivors treated on standard protocols. The increase in afterload accounted for reduced LV shortening, whereas contractility was rarely abnormal. The new finding that Wilms' tumor survivors who do not receive anthracyclines have mild LV hypertrophy may provide some protection against anthracycline-induced cardiotoxic effects. (C) 1995 by American Society of Clinical Oncology.