Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort
Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort
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DOI：
10.1016/s0140-6736(22)02471-0
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发表时间：
2023-04-27
期刊：
影响因子：
168.9
通讯作者：
Armstrong, Gregory
中科院分区：
文献类型：
--
作者：
Dixon, Stephanie B.;Liu, Qi;Armstrong, Gregory
儿童癌症后5年生存率并不能完全描述儿童癌症造成的生命年损失，因为有大量死亡发生在5年以上（晚期死亡率），与癌症和癌症治疗有关。与健康有关的（非复发、非外部）晚期死亡的具体原因以及通过改变生活方式和心血管风险因素降低风险的情况没有得到很好的描述。通过使用最常见的儿童癌症的5年存活者的良好特征的队列，我们评估了与一般美国人群相比晚期死亡率和过量死亡的特定健康相关原因，并确定了降低未来风险的目标。晚期死亡率（诊断后死亡>= 5年）和具体死亡原因进行了评估，34 230 5-从1970年到1999年，在美国和加拿大的31个机构中，在21岁以下诊断出儿童癌症的1岁存活者;在儿童癌症幸存者研究中，诊断后的中位随访时间为29年（范围5-48）。人口统计学，自我报告的可改变的生活方式（即吸烟、饮酒、体力活动和BMI）和心血管风险因素（即高血压、糖尿病、和血脂异常）与健康相关死亡率相关结果40年累积全因死亡率为23.3%，（95% CI 22中心点7-24中心点0），5916例死亡中有3061例（51中心点2%）死于健康相关原因。诊断后40年或更长时间的幸存者每10000人年经历131例额外的健康相关死亡（95% CI 111-163），包括一般人群中健康相关死亡的前三大原因：癌症（每10 000人-年的绝对超额风险54，95% CI 41-68）、心脏病（27，18-38）和脑血管疾病（10，5-17）。健康的生活方式和没有高血压和糖尿病分别与20-30%的健康相关死亡率降低相关，与其他因素无关（所有p值
Background 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk.Methods In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death >= 5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated.Findings 40-year cumulative all-cause mortality was 23 center dot 3% (95% CI 22 center dot 7-24 center dot 0), with 3061 (51 center dot 2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values