背景:心血管疾病(CVD)是诊断为癌症的青少年和年轻人(AYAs)发病和死亡的主要原因。这项研究的目的是评估接受VEGF抑制的AYAs与非AYAs相比,左心室收缩功能障碍(LVSD)和高血压的发生率和预测因素。
方法:本回顾性分析使用来自ASSURE试验的数据(ClinicalTrials.gov标识符:NCT00326898),其中非转移性参与者,高风险,肾细胞癌被随机分配到舒尼替尼,索拉非尼,或安慰剂。使用非参数检验比较LVSD(左心室射血分数下降>15%)和高血压(血压≥140/90mmHg)的发生率。多变量逻辑回归检查了AYA状态之间的关联,LVSD,和高血压,同时调整临床因素。
结果:AYAs占人口的7%(103/1,572)。在54周的研究治疗期间,AYAs(3%;95%CI,0.6%-8.3%)与非AYAs(2%;95%CI,1.2%-2.7%)的LVSD发生率无显著差异.与安慰剂组的非AYAs(46%;95%CI,41.9%-50.4%)相比,AYAs中的高血压发生率显着降低(18%;95%CI,7.5%-33.5%)。在舒尼替尼和索拉非尼组,与非AYAs相比,AYAs的高血压发病率为29%(95%CI,15.1%-47.5%)与47%(95%CI,42.3%-51.7%),54%(95%CI,33.9%-72.5%)与63%(95%CI,58.6%-67.7%),分别。AYA状态(赔率比,0.48;95%CI,0.31-0.75)和女性(赔率比,0.74;95%CI,0.59-0.92)均与较低的高血压风险相关。
结论:LVSD和高血压在AYAs中普遍存在。AYAs中的CVD仅部分由癌症治疗解释。了解AYA癌症幸存者的CVD风险对于促进这一不断增长的人群的心血管健康非常重要。
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among adolescents and young adults (AYAs) diagnosed with cancer. The aim of this study was to assess the incidence and predictors of left ventricular systolic dysfunction (LVSD) and hypertension among AYAs receiving VEGF inhibition compared with non-AYAs.
This retrospective analysis used data from the ASSURE trial (ClinicalTrials.gov identifier: NCT00326898), in which participants with nonmetastatic, high-risk, renal cell cancer were randomized to sunitinib, sorafenib, or placebo. The incidence of LVSD (left ventricular ejection fraction decrease >15%) and hypertension (blood pressure ≥140/90 mm Hg) were compared using nonparametric tests. Multivariable logistic regression examined the association between AYA status, LVSD, and hypertension while adjusting for clinical factors.
AYAs represented 7% (103/1,572) of the population. Over a study treatment period of 54 weeks, the incidence of LVSD was not significantly different among AYAs (3%; 95% CI, 0.6%-8.3%) versus non-AYAs (2%; 95% CI, 1.2%-2.7%). The incidence of hypertension was significantly lower among AYAs (18%; 95% CI, 7.5%-33.5%) compared with non-AYAs (46%; 95% CI, 41.9%-50.4%) in the placebo arm. In the sunitinib and sorafenib groups, the incidence of hypertension for AYAs compared with non-AYAs was 29% (95% CI, 15.1%-47.5%) versus 47% (95% CI, 42.3%-51.7%), and 54% (95% CI, 33.9%-72.5%) versus 63% (95% CI, 58.6%-67.7%), respectively. AYA status (odds ratio, 0.48; 95% CI, 0.31-0.75) and female sex (odds ratio, 0.74; 95% CI, 0.59-0.92) were each associated with a lower risk of hypertension.
LVSD and hypertension were prevalent among AYAs. CVD among AYAs is only partially explained by cancer therapy. Understanding CVD risk among AYA cancer survivors is important for promoting cardiovascular health in this growing population.