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IF 28.4 1区医学 Q1 Biochemistry, Genetics and Molecular Biology

Jama Oncology Pub Date : 2025-03-20 DOI:10.1001/jamaoncol.2025.0236

Jennifer M Yeh, Zachary J Ward, Kayla L Stratton, Mercedes V McMahon, Chelsea S Taylor, Gregory T Armstrong, Eric J Chow, Melissa M Hudson, Lindsay M Morton, Kevin C Oeffinger, Lisa R Diller, Wendy M Leisenring

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引用次数: 0

摘要

重要性：儿童癌症幸存者终生罹患衰老相关疾病的风险因癌症治疗暴露而加速，但这一风险尚不清楚。了解这一风险可以更全面地评估幸存者一生中的长期健康状况，并为成人护理提供指导：估计儿童癌症幸存者一生中患 8 种与治疗相关的癌症和心血管疾病的风险，并将其与普通人群进行比较：这项模拟建模研究利用儿童癌症幸存者研究（Childhood Cancer Survivor Study）和国家数据库中的数据，根据治疗暴露和年龄相关风险，预测了1970年至1999年间确诊的5年期幸存者的长期预后。普通人群的比较对象是年龄、性别和日历年匹配的个体，他们只面临与年龄相关的风险：治疗年代（20 世纪 70 年代、80 年代、90 年代）、最初的癌症诊断、主要诊断的放射治疗（任何、无）：估计8种健康状况（乳腺癌、结直肠癌、胶质瘤、肉瘤、心力衰竭、冠心病/心肌梗塞、中风和瓣膜病）的终生风险。对风险进行了预测，并按辐射照射分层与普通人群进行了比较：在普通人群中，20%的人到 65.0 岁时至少会出现一种健康问题；在 5 年期幸存者中，47.3 岁时达到了这一临界值，这意味着疾病的发病时间加快了 17.7 年（95% 不确定区间 [UI]，14.0-21.0）。预计到 65 岁时，55% 的幸存者将至少罹患一种疾病，与普通人群相比，相对风险高出 2.7 倍（95% UI，2.2-3.5），绝对超额风险高出 34.2%（95% UI，28.3-42.5）。接受过放射治疗的儿童癌症患者的风险更高（提前 22.0 年发病[95% UI，18.0-25.0]；37.3% 的超额风险[95% UI，31.6%-44.7%]），但未接受过放射治疗的患者的风险仍然较高（提前 13.5 年发病[95% UI，10.0-16.0]；31.0% 的超额风险[95% UI，23.9%-40.3%]）。人到中年，健康风险仍会增加。与普通人群相比，年满 40 岁的幸存者在 10 年内出现新病症的风险高出 6.2 倍（95% UI，4.8-9.4）：本研究发现，儿童癌症幸存者会加速罹患与衰老相关的疾病，而与之前的辐射照射无关。这些发现强调了将预防癌症和心血管疾病作为优先事项的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Accelerated Aging in Survivors of Childhood Cancer-Early Onset and Excess Risk of Chronic Conditions.

Importance: The lifetime risk of aging-related diseases among survivors of childhood cancer, accelerated by cancer treatment exposures, is unknown. Understanding this risk can provide a more comprehensive assessment of long-term health across the lifespan of survivors and guide adult care.

Objective: To estimate the lifetime risks of 8 treatment-related cancers and cardiovascular conditions among childhood cancer survivors and compare them with the general population.

Design, setting, participants: Using data from the Childhood Cancer Survivor Study and national databases, this simulation modeling study projected long-term outcomes for 5-year survivors diagnosed between 1970 and 1999 based on treatment exposures and age-related risks. The general population comparator was simulated using age-, sex-, and calendar year-matched individuals who faced only age-related risks.

Exposures: Treatment era (1970s, 1980s, 1990s), original cancer diagnosis, radiation treatment for primary diagnosis (any, none).

Main outcomes and measures: Estimated lifetime risks of 8 health conditions (breast cancer, colorectal cancer, glial tumors, sarcomas, heart failure, coronary heart disease/myocardial infarction, stroke, and valvular disease). Risks were projected and compared with the general population, stratified by radiation exposure.

Results: In the general population, 20% developed at least 1 health condition by age 65.0 years; in 5-year survivors this threshold was reached at age 47.3 years, representing a 17.7-year (95% uncertainty interval [UI], 14.0-21.0) acceleration in disease onset. By age 65 years, 55% of survivors were projected to develop at least 1 condition, indicating a 2.7-fold (95% UI, 2.2-3.5) higher relative risk and 34.2% (95% UI, 28.3-42.5) absolute excess risk compared with the general population. Risks were higher among those treated with radiation therapy for childhood cancer (22.0 years earlier onset [95% UI, 18.0-25.0]; 37.3% excess risk [95% UI, 31.6%-44.7%]) but still elevated for those without radiation exposure (13.5 years earlier onset [95% UI, 10.0-16.0]; 31.0% excess risk [95% UI, 23.9%-40.3%]). Reaching middle age was still associated with increased health risks. Compared with the general population, survivors who reached age 40 years had a 6.2-fold higher risk (95% UI, 4.8-9.4) of developing a new condition within 10 years.

Conclusions and relevance: This study found that survivors of childhood cancer experience accelerated onset of aging-related diseases, regardless of prior radiation exposure. These findings underscore the importance of prioritizing cancer and cardiovascular disease prevention among survivors decades earlier than for the general population.

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来源期刊

Jama Oncology Medicine-Oncology

CiteScore

37.50

自引率

1.80%

发文量

423

期刊介绍： At JAMA Oncology, our primary goal is to contribute to the advancement of oncology research and enhance patient care. As a leading journal in the field, we strive to publish influential original research, opinions, and reviews that push the boundaries of oncology science. Our mission is to serve as the definitive resource for scientists, clinicians, and trainees in oncology globally. Through our innovative and timely scientific and educational content, we aim to provide a comprehensive understanding of cancer pathogenesis and the latest treatment advancements to our readers. We are dedicated to effectively disseminating the findings of significant clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our ultimate objective is to facilitate the translation of new knowledge into tangible clinical benefits for individuals living with and surviving cancer.