Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer
Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer
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DOI：
10.1200/jco.2017.74.8673
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发表时间：
2018-01-01
影响因子：
45.3
通讯作者：
Yasui, Yutaka
中科院分区：
文献类型：
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作者：
Chow, Eric J.;Chen, Yan;Yasui, Yutaka
目的：预测5年儿童癌症幸存者发生缺血性心脏病和脑卒中的个体风险。患者和方法儿童癌症幸存者研究（CCSS; n = 13060）的参与者在50岁之前观察缺血性心脏病和中风的发展情况。兄弟姐妹（n = 4023）确定了基线人群风险。带逆向选择的分段指数模型估计了潜在预测因子与每个结果之间的关系。采用St Jude终身队列研究（n = 1,842）和Emma儿童医院队列研究（n = 1,362）来验证CCSS模型。结果CCSS参与者中分别有265人和295人发生缺血性心脏病和中风。基于标准预测模型（包括性别、化疗和放疗（颅、颈、胸）暴露）的风险评分，缺血性心脏病的曲线下面积和一致性统计分别为0.70和0.70，卒中的一致性统计为0.63和0.66。验证队列曲线下面积和一致性统计在缺血性心脏病为0.66 ~ 0.67，卒中为0.68 ~ 0.72。风险评分被分解成统计上不同的低、中、高风险组。CCSS低危组50岁时的累计发病率为
PurposeWe aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer.Patients and MethodsParticipants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children's Hospital cohort (n = 1,362) were used to validate the CCSS models.ResultsIschemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were