Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors - Childhood Cancer Survivor Study
Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors - Childhood Cancer Survivor Study
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DOI：
10.1002/cncr.11095
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发表时间：
2003-02-01
期刊：
影响因子：
6.2
通讯作者：
Robison, LL
中科院分区：
文献类型：
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作者：
Gurney, JG;Kadan-Lottick, NS;Robison, LL
背景儿童期脑肿瘤（CBTs）的幸存者具有各种晚期不良反应的高风险。大多数关于CBT长期影响的研究都是由单机构病例系列组成，没有比较组。关于CBT迟发效应的研究通常集中在神经和感觉结果上，而不太重视其他潜在的靶点，如内分泌和循环系统。当前的研究旨在比较CBT幸存者中内分泌和心血管疾病的发生率与治疗的关系，并确定相对于兄弟姐妹比较组发生这些疾病的风险。方法。作为儿童癌症幸存者研究（CCSS）的一部分，从医疗记录中收集治疗数据，并从1607名存活5年或更长时间的CBT患者的调查问卷中确定自我报告的晚期效应。为了比较的目的，问卷调查数据也收集了3418随机选择的兄弟姐妹在CCSS. CRITS的参与者。43%的CBT幸存者报告了一种或多种内分泌疾病。与兄弟姐妹相比，CBT幸存者迟发性（诊断后5年以上）甲状腺功能减退（相对风险[RR] = 14.3; 95%置信区间[95% CI] 9.7-21.0），生长激素缺乏症（RR = 277.8; 95% CI 111.1-694.9）、需要药物诱导青春期（RR 86.1; 95% CI 31.1-238.2）和骨质疏松症（RR = 24.7; 95% CI 9.9-61.4）。18%的CBT幸存者报告了一种或多种心血管疾病，卒中（RR = 42.8; 95% CI 16.7-109.8）、血凝块（RR = 5.7; 95% CI 3.2-10.0）和心绞痛样症状（RR = 2.0; 95% CI 1.5-2.7）的迟发风险升高。仅手术治疗的患者几乎没有明显的晚期效应，但放疗和手术治疗的患者的风险持续升高，同时接受辅助化疗的患者的风险更高。儿童脑肿瘤幸存者发生几种不良内分泌和心血管晚期效应的风险显著增加，特别是如果他们接受放疗和化疗。终生医学监测和潜在毒性的随访是必要的，因为治疗相关并发症可能在治疗后多年发生。癌症2003;97：663-73. (C)2003年美国癌症协会。
BACKGROUND. Survivors of childhood brain tumors (CBTs) are at high risk for a variety of late adverse effects. Most research on long-term effects of CBTs has been comprised of single-institution case series without comparison groups. Research on CBT late effects often is focused on neurologic and sensory outcomes, with less emphasis on other potential targets such as the endocrine and circulatory systems. The current study was conducted to contrast the incidence of endocrine and cardiovascular conditions among CBT survivors as a function of treatment and to determine the risk of occurrence of these conditions relative to a sibling comparison group.METHODS. As part of the Childhood Cancer Survivor Study (CCSS), treatment data were collected from medical records and self-reported late effects were ascertained from a survey questionnaire of 1607 CBT patients who survived their disease for 5 or more years. For comparison purposes, questionnaire data were also collected from 3418 randomly selected siblings of participants in CCSS.RESULTS. one or more endocrine conditions were reported by 43% of CBT survivors. Compared with siblings, CBT survivors had a significantly increased risk of late-onset (greater than or equal to 5 years postdiagnosis) hypothyroidism (relative risk [RR] = 14.3; 95% confidence interval [95% Cl] 9.7-21.0), growth hormone deficiency (RR = 277.8; 95% Cl 111.1-694.9), the need for medications to induce puberty (RR 86.1; 95% CI 31.1-238.2), and osteoporosis (RR = 24.7; 95% Cl 9.9-61.4). One or more cardiovascular conditions were reported by 18% of CBT survivors, with an elevated late-onset risk for stroke (RR = 42.8; 95% Cl 16.7-109.8), blood clots (RR = 5.7; 95% Cl 3.2-10.0), and angina-like symptoms (RR = 2.0; 95% Cl 1.5-2.7). Very few late effects were evident among those treated with surgery only, but risks were consistently elevated for those treated with radiation and surgery, and higher still for those who also received adjuvant chemotherapy.CONCLUSIONS. Childhood brain tumor survivors are at a significantly increased risk for several adverse endocrine and cardiovascular late effects, particularly if they were treated with radiation and chemotherapy. Lifetime medical surveillance and follow-up for potential toxicities are necessary because treatment-related complications may occur many years after therapy. Cancer 2003;97:663-73. (C) 2003 American Cancer Society.