Factors affecting late mortality from heart disease after treatment of Hodgkin's disease.
Factors affecting late mortality from heart disease after treatment of Hodgkin's disease.
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DOI：
10.1001/jama.1993.03510160067031
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发表时间：
1993-10
期刊：
影响因子：
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通讯作者：
S. Hancock;M. Tucker;R. Hoppe
中科院分区：
文献类型：
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作者：
S. Hancock;M. Tucker;R. Hoppe
目的评估霍奇金病治疗后心脏病死亡的风险。设计：回顾性研究，比较治疗的患者与匹配的一般人群。环境转介中心。从1960年到1991年，共有2232例连续的霍奇金病患者接受治疗。平均随访9.5年。主要观察指标：相对风险（RR）、观察病例与预期病例的比值及95%置信区间（CI）、趋势卡方检验和Kaplan-Meier精算风险。结果2232例患者中，88例（3.9%）死于心脏病，55例死于急性心肌梗死，33例死于其他心脏病，包括充血性心力衰竭、放射性心包炎或全心炎、心肌病、心脏瓣膜病。心源性死亡的RR为3.1（CI，2.4 - 3.7）。385例患者接受30戈伊或更低剂量的纵隔放射治疗不会增加风险; 1830例患者接受30戈伊以上剂量的纵隔放射治疗，RR为3.5（CI，2.7 - 4.3）。限制心脏暴露的阻断措施使其他心脏疾病的RR从5.3（CI，3.1至7.5）降低至1.4（CI，0.6至2.9），但急性心肌梗死的RR没有降低（RR，3.7 vs 3.4）。RR随治疗后持续时间增加（急性心肌梗死趋势，P = 0.02;其他心脏疾病，P = 0.004）。急性心肌梗死的RR在20岁之前照射后最高，并随着治疗时年龄的增加而下降（趋势P <0.0001）。结论：霍奇金病的纵隔放疗增加了随后死于心脏病的风险。风险随着高纵隔剂量、最小保护性心脏阻滞、年轻时接受照射和随访时间的增加而增加。
OBJECTIVE To assess the risk of death from heart disease after Hodgkin's disease therapy. DESIGN Retrospective study comparing treated patients with a matched general population. SETTING Referral center. PATIENTS A total of 2232 consecutive Hodgkin's disease patients treated from 1960 through 1991. Follow-up averaged 9.5 years. MAIN OUTCOME MEASURES Relative risks (RRs), the ratio of the observed to the expected cases with 95% confidence intervals (CIs), chi tests for trends, and Kaplan-Meier actuarial risks. RESULTS Of the 2232 patients, 88 (3.9%) died of heart disease, 55 from acute myocardial infarction and 33 from other cardiac diseases, including congestive heart failure, radiation pericarditis or pancarditis, cardiomyopathy, or valvular heart disease. The RR for cardiac death was 3.1 (CI, 2.4 to 3.7). Mediastinal radiation of 30 Gy or less (n = 385 patients) did not increase risk; above 30 Gy (n = 1830), RR was 3.5 (CI, 2.7 to 4.3). Blocking to limit cardiac exposure reduced the RR for other cardiac diseases from 5.3 (CI, 3.1 to 7.5) to 1.4 (CI, 0.6 to 2.9), but not acute myocardial infarction (RR, 3.7 vs 3.4). The RRs increased with duration after treatment (trend in acute myocardial infarction, P = .02; in other cardiac diseases, P = .004). The RR for acute myocardial infarction was highest after irradiation before 20 years of age and decreased with increasing age at treatment (P < .0001 for trend). CONCLUSIONS Mediastinal irradiation for Hodgkin's disease increases the risk of subsequent death from heart disease. Risk increased with high mediastinal doses, minimal protective cardiac blocking, young age at irradiation, and increasing duration of follow-up.