Increased Cardiac Risk After a Second Malignant Neoplasm Among Childhood Cancer Survivors: A FCCSS Study.
JACC CardioOncol
; 5(6): 792-803, 2023 Dec.
Article
em En
| MEDLINE
| ID: mdl-38205003
ABSTRACT
Background:
Childhood cancer survivors (CCS) are at an elevated risk of developing both a second malignant neoplasm (SMN) and cardiac disease.Objectives:
This study sought to assess the excess of occurrence of cardiac disease after a SMN among CCS.Methods:
Analyses included 7,670 CCS from the French Childhood Cancer Survivors Study cohort diagnosed between 1945 and 2000. To account for the time dependence of the occurrence of a SMN, we employed a landmark approach, considering an additive regression model for the cumulative incidence of cardiac disease. We estimated the effect of a SMN on the instantaneous risk of cardiac disease using a proportional cause-specific hazard model, considering a SMN as a time-dependent exposure. In both models, we adjusted for demographic and treatment information and considered death as a competing event.Results:
In 7,670 CCS over a median follow-up of 30 years (IQR 22-38 years), there were 378 cases of cardiac disease identified, of which 49 patients experienced a SMN. Patients who survived 25 years after their childhood cancer diagnosis and had a SMN in that time frame had a significantly increased cumulative incidence of cardiac disease, which was 3.8% (95% CI 0.5% to 7.1%) higher compared with those without a SMN during this period. No SMN-induced excess of cardiac disease was observed at subsequent landmark times. SMNs were associated with a 2-fold increase (cause-specific HR 2.0; 95% CI 1.4-2.8) of cardiac disease.Conclusions:
The occurrence of a SMN among CCS is associated with an increased risk of cardiac disease occurrence and risk at younger ages.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Etiology_studies
/
Risk_factors_studies
Idioma:
En
Revista:
JACC CardioOncol
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
França