Cardiovascular disease as a long-term complication of treatment for testicular cancer
Cardiovascular disease as a long-term complication of treatment for testicular cancer
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DOI：
10.1200/jco.2003.04.173
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发表时间：
2003-04-15
影响因子：
45.3
通讯作者：
Dearnaley, DP
中科院分区：
文献类型：
--
作者：
Huddart, RA;Norman, A;Dearnaley, DP
目的：为了评估睾丸癌的长期生存者的心血管疾病的发病率和心脏危险因素的风险，根据treatment received.Patients和方法：所有居民男性患者在英国登记1982年和1992年之间参加后续有资格招募。患者完成了当前的健康调查问卷，并进行了临床审查，沿着血液学，生化和激素的档案。对于未接受常规审查的患者，从其全科医生处获取随访信息，并从国家统计局获取死亡率数据。对所有变量进行描述性分析，并对接受腰椎切除术和仅随访、单纯化疗（C）、单纯放疗（RT）以及放疗和化疗的患者进行比较。结果：992例患者的心血管事件数据可用。在中位随访10.2年后，报告了68起事件，包括18例死亡。校正年龄后，C组心脏事件风险增加，（相对风险[RR] = 2.59; 95%置信区间[CI]，1.15 - 5.84; P = .022），RT（RR = 2.40; 95% CI，1.04至5.45; P = .036）和C/RT（RR = 2.78; 95% CI，1.09至7.07; P = .032）。心脏危险因素无显著差异。在多变量分析，年龄，治疗组，游离甲状腺素，蛋白质，镁水平与心血管疾病。结论：在长期生存的睾丸癌，我们观察到一个两倍或更大的风险发展为心血管疾病。这不是由于心脏风险因素增加，这表明直接或间接的治疗效果。这些数据支持对预后良好的睾丸癌进行最小化治疗的持续研究。(C)2003年，美国临床肿瘤学会。
Purpose: To assess the risk of cardiovascular morbidity and cardiac risk factors in long-term survivors of testicular cancer according to treatment received.Patients and Methods: All resident male patients registered in the United Kingdom between 1982 and 1992 attending for follow-up were eligible for recruitment. Patients completed a current health questionnaire and underwent clinical review, along with hematologic, biochemical, and hormonal profiles. For patients not under routine review, follow-up information was sought from their general practitioner and mortality data were sought from the Office of National Statistics. Descriptive analysis was performed on all variables and comparisons were made among patients treated by orchidectomy and follow-up only, chemotherapy alone (C), radiotherapy alone (RT), and radiotherapy and chemotherapy. (C/RT).Results: Data on cardiovascular events were available on 992 patients. After a median follow-up of 10.2 years, 68 events had been reported, including 18 deaths. After adjusting for age, increased risk for cardiac events was seen after C (relative risk [RR] = 2.59; 95% confidence interval [CI], 1.15 to 5.84; P = .022), RT (RR = 2.40; 95% CI, 1.04 to 5.45; P = .036), and C/RT (RR = 2.78; 95% CI, 1.09 to 7.07; P = .032). There were no significant differences in cardiac risk factors. On multivariate analysis, age, treatment group, free thyroxine, protein, and magnesium levels were associated with cardiovascular disease.Conclusion: In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer. (C) 2003 by American Society of Clinical Oncology.