Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study.
Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study.
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DOI：
10.1161/circulationaha.116.022514
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发表时间：
2016-11-15
期刊：
影响因子：
37.8
通讯作者：
Hawkins MM
中科院分区：
文献类型：
--
作者：
Henson KE;Reulen RC;Winter DL;Bright CJ;Fidler MM;Frobisher C;Guha J;Wong KF;Kelly J;Edgar AB;McCabe MG;Whelan J;Cutter DJ;Darby SC;Hawkins MM
文本中提供了补充数字内容。青少年和年轻成人癌症的幸存者被认为尚未得到充分研究。人们对它们的长期不良健康风险知之甚少，特别是在使用心脏毒性治疗的其他癌症人群中增加的心脏病风险。青少年和年轻人癌症幸存者研究队列包括 1971 年至 2006 年英格兰和威尔士 200 945 名 15 至 39 岁的癌症 5 年幸存者，随访至 2014 年。计算了标准化死亡率、绝对超额风险和累积风险。两千一十六名幸存者死于心脏病。对于所有癌症的总和，所有心脏病的标准化死亡率在 15 至 19 岁诊断的个体中最高（4.2；95% 置信区间，3.4–5.2），在 35 至 39 岁的个体中降至 1.2（95% 置信区间，1.1–1.3）（2P 趋势<0.0001）。缺血性心脏病、瓣膜性心脏病和心肌病的标准化死亡率和绝对超额风险也观察到类似的模式。霍奇金淋巴瘤、急性髓系白血病、膀胱癌以外的泌尿生殖系统癌症、非霍奇金淋巴瘤、肺癌、急性髓系以外的白血病、中枢神经系统肿瘤、宫颈癌和乳腺癌的幸存者数量增加了3.8、2.7、2.0、1.7、1.7、1.6、1.4、1.3和1.2倍一般人群预期的心脏死亡人数分别为在 60 岁以上的霍奇金淋巴瘤幸存者中，观察到的超额死亡总数中近 30% 是由于心脏病造成的。这项针对 200 多名癌症幸存者的研究表明，癌症诊断时的年龄对于确定随后的心脏死亡风险至关重要。首次对 15 岁至 39 岁之间诊断出的每种癌症后心源性死亡的风险评估来自于长期随访的大型人群队列。这里的证据为制定循证后续指南提供了初步基础。
Supplemental Digital Content is available in the text. Survivors of teenage and young adult cancer are acknowledged as understudied. Little is known about their long-term adverse health risks, particularly of cardiac disease that is increased in other cancer populations where cardiotoxic treatments have been used. The Teenage and Young Adult Cancer Survivor Study cohort comprises 200 945 5-year survivors of cancer diagnosed at 15 to 39 years of age in England and Wales from 1971 to 2006, and followed to 2014. Standardized mortality ratios, absolute excess risks, and cumulative risks were calculated. Two thousand sixteen survivors died of cardiac disease. For all cancers combined, the standardized mortality ratios for all cardiac diseases combined was greatest for individuals diagnosed at 15 to 19 years of age (4.2; 95% confidence interval, 3.4–5.2) decreasing to 1.2 (95% confidence interval, 1.1–1.3) for individuals aged 35 to 39 years (2P for trend <0.0001). Similar patterns were observed for both standardized mortality ratios and absolute excess risks for ischemic heart disease, valvular heart disease, and cardiomyopathy. Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively. Among survivors of Hodgkin lymphoma aged over 60 years, almost 30% of the total excess number of deaths observed were due to heart disease. This study of over 200 000 cancer survivors shows that age at cancer diagnosis was critical in determining subsequent cardiac mortality risk. For the first time, risk estimates of cardiac death after each cancer diagnosed between the ages of 15 and 39 years have been derived from a large population-based cohort with prolonged follow-up. The evidence here provides an initial basis for developing evidence-based follow-up guidelines.