Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study.
Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study.
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DOI：
10.1016/j.ijrobp.2013.03.034
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发表时间：
2013-07-15
影响因子：
7
通讯作者：
Krull, Kevin R.
中科院分区：
文献类型：
--
作者：
Mueller, Sabine;Fullerton, Heather J.;Stratton, Kayla;Leisenring, Wendy;Weathers, Rita E.;Stovall, Marilyn;Armstrong, Gregory T.;Goldsby, Robert E.;Packer, Roger J.;Sklar, Charles A.;Bowers, Daniel C.;Robison, Leslie L.;Krull, Kevin R.
儿童颅脑放射治疗(CRT)对成年后卒中风险的影响，以及可改变的动脉粥样硬化危险因素的作用，仍然没有明确的定义。我们评估了儿童癌症幸存者的长期发病率和中风危险因素，随后进行了儿童癌症幸存者研究(CCSS)。CCSS是一项多机构的回顾性队列研究，对14,358名儿童癌症五年幸存者和4,023名随机选择的同胞对照进行纵向随访。计算年龄调整后的自我报告的迟发性(≥诊断后5年)首次中风的发生率。多变量Cox比例风险模型被用来识别独立的卒中预测因素。在平均23.3年的随访中，292名幸存者报告了迟发性中风。年龄调整后的每100,000人年中风发生率为77(95%可信区间[CI]62-96)，而兄弟姐妹为9.3(95%可信区间4-23)。CRT治疗以剂量依赖的方式增加中风风险：30-49GyCRT的风险比(HR)为5.9(95%CI 3.5-9.9)，50+GyCRT的风险比(HR)为11.0(7.4-17.0)。接受50+GyCRT治疗的幸存者的累积卒中发生率在诊断后10年为1.1%(95%可信区间0.4~1.8)，在30年后为12%(95%可信区间8.9~15.0)。高血压(HTN)使中风风险增加4倍(95%可信区间2.8-5.5)，黑人幸存者中风风险增加16倍(95%可信区间6.9-36.6)。年轻的儿童癌症幸存者中风风险增加，这与CRT以剂量依赖的方式相关。动脉粥样硬化的危险因素增加了这种风险，应该积极治疗。
The impact of childhood cranial radiation therapy (CRT) on stroke risk in adulthood, and the role of modifiable atherosclerotic risk factors, remains poorly defined. We assessed long-term incidence rates and stroke risk factors in survivors of childhood cancer followed by the Childhood Cancer Survivor Study (CCSS). CCSS is a multi-institutional retrospective cohort study of 14,358 five-year survivors of childhood cancer and 4,023 randomly selected sibling controls with longitudinal follow up. Age-adjusted incidence rates of self-reported late-occurring (≥ 5 years after diagnosis) first-stroke were calculated. Multivariable Cox Proportional Hazards models were used to identify independent stroke predictors. During a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95% Confidence Interval [CI] 62–96) compared to 9.3 (95% CI 4–23) for siblings. Treatment with CRT increased stroke risk in a dose dependent manner: hazard ratio (HR) 5.9 (95% CI 3.5–9.9) for 30–49 Gy CRT, and 11.0 (7.4–17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1% (95% CI 0.4–1.8) at 10 years post-diagnosis and 12% (95% CI 8.9–15.0) at 30 years. Hypertension (HTN) increased stroke hazard by 4-fold (95% CI 2.8–5.5) and in black survivors by 16-fold (95% CI 6.9–36.6). Young adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.
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DOI：
10.1016/s0360-3016(97)82497-2
发表时间：
1997-05-01
影响因子：
7
作者：
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通讯作者：
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影响因子：
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45.3
作者：
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Bartelink, H
影响因子：
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Waddy SP;Cotsonis G;Lynn MJ;Frankel MR;Chaturvedi S;Williams JE;Chimowitz M
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