Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma
Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma
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DOI：
10.1182/blood-2005-08-3392
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发表时间：
2006-04-01
期刊：
影响因子：
20.3
通讯作者：
Kluin-Nelemans, HC
中科院分区：
文献类型：
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作者：
Moser, EC;Noordijk, EM;Kluin-Nelemans, HC
淋巴瘤治疗后经常发生心血管疾病，但在普通人群中也很常见。因此，风险评估需要与基于人群的比率进行比较。我们根据总人口发生率（奈梅亨连续发病率登记处）计算了每 10 000 人年的标准化发病率 (SIR) 和绝对超额风险 (AER)，在 4 项欧洲癌症治疗研究组织 (EORTC) 试验中，对 476 名（荷兰和比利时）侵袭性非霍奇金淋巴瘤 (NHL) 患者进行了至少 6 个周期的基于阿霉素的化疗治疗，计算了风险（1980-1999）。根据竞争风险模型估计，心血管疾病的累积发病率在 5 年时为 12%，在 10 年时为 22%（中位随访时间为 8.4 年）。慢性心力衰竭的风险似乎显着增加（SIR，5.4；95% CI，4.1-6.9），AER 为每 10000 人年 208 例超额病例，而冠状动脉疾病的风险与一般人群相匹配（SIR，1.2；95% CI，0.8-1.8；AER，每 10000 人年 8 例）。中风风险增加（SIR，1.8；95% CI，1.1-2.4；AER，每 10 000 人年 15 例），特别是在额外放疗（> 40 Gy）后。先前存在的高血压、年轻时的 NHL 以及挽救治疗会增加所有心血管事件的风险；放射治疗的效果是剂量依赖性的。总之，NHL 治疗后患者长期处于慢性心力衰竭的高风险中，因此需要终身监测。相比之下，冠状动脉疾病的风险似乎更多地取决于年龄，而不是与治疗相关。
Cardiovascular disease frequently occurs after lymphoma therapy, but it is common in the general population too. Therefore, risk estimation requires comparison to population -based rates. We calculated risk by standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10 000 person-years based on general population rates (Continuous Morbidity Registry Nijmegen) in 476 (Dutch and Belgian) patients with aggressive non-Hodgkin lymphoma (NHL) treated with at least 6 cycles of doxorubicin-based chemotherapy in 4 European Organization for Research on Treatment of Cancer (EORTC) trials (1980-1999). Cumulative incidence of cardiovascular disease, estimated in a competing risk model, was 12% at 5 years and 22% at 10 years (median follow-up, 8.4 years). Risk of chronic heart failure appeared markedly increased (SIR, 5.4; 95% CI, 4.1-6.9) with an AER of 208 excess cases per 10 000 person-years, whereas risk of coronary artery disease matched the general population (SIR, 1.2; 95% CI, 0.8-1.8; AER, 8 per 10 000 person-years). Risk of stroke was raised (SIR, 1.8; 95% CI, 1.1-2.4; AER, 15 per 10 000 person-years), especially after additional radiotherapy (> 40 Gy). Preexisting hypertension, NHL at young age, and salvage treatment increased risk of all cardiovascular events; the effect of radiotherapy was dose dependent. In conclusion, patients are at longterm high risk of chronic heart failure after NHL treatment and need therefore life-long monitoring. In contrast, risk of coronary artery disease appeared more age dependent than treatment related.