Key result
Total body irradiation is linked to a ~170% higher hypercholesterolaemia risk in childhood cancer survivors.
Why the study?
The distribution and relationships between anticancer therapies and cardiovascular risk factors in childhood cancer survivors have been heterogeneously and not prospectively described.
Cohort (n=340)
Hazard Ratio: 2.7 (95% CI 1.2–4.4)
p-value: p=<0.05
Childhood cancer survivors face a high risk of developing dyslipidaemia and obesity, which is strongly influenced by specific prior cancer treatments such as total body irradiation and platinum-based chemotherapy.
Supports treatment-specific lipid monitoring in CCSs; extends therapy-linked dyslipidaemia associations from observational data.
BACKGROUND: Childhood cancer survivors (CCSs) have an increased risk of overweight and dyslipidaemia, but the distribution and the potential relationships between anticancer therapies and cardiovascular risk factors have been heterogeneously and not prospectively described. METHODS: All consecutive CCSs with primary cancer diagnosed between 1973-2007 and subsequently referred to our outpatient clinic were enrolled. Hypercholesterolaemia (total cholesterol >200 and/or low density lipoprotein (LDL)>160 mg/dl) was the primary end point, hypertriglyceridaemia (triglycerides >200 mg/dl) and body mass index >30 kg/m(2) the secondary end points. Cox multivariate adjustments were performed to account for differences in cancer and treatments. RESULTS: A total of 340 patients were included (197 male, 143 female; mean age at last follow-up 24.1 ± 3.2). The most common diagnosis were haematological malignancies (n = 227) and brain tumours (n = 51). After a median follow-up of 16.1 years, hypercholesterolaemia was diagnosed in 67 CCSs (20%), hypertriglyceridaemia in 20 CCSs (6%) and obesity in 28 CCSs (8%). Total body irradiation and growth hormone deficiency increased the risk of both hypercholesterolaemia (hazard ratio (HR) = 2.7; confidence interval (CI) 1.2-4.4 and HR = 2.3; CI 1.1-4.9; all p < 0.05) and hypertriglyceridaemia (HR = 6.5; CI 1.4-31 and HR = 7.2; CI 1.1-43; all p < 0.05). The risk of hypercholesterolaemia was also higher in CCSs who underwent autologous haematopoietic stem cell transplantation (HR = 3.2; CI 1.7-5.9; p < 0.001) or platinum-based chemotherapy (HR = 2.7; CI 1.5-4.9; p < 0.001), whereas a previous diagnosis of brain tumour (HR = 10; CI 1.2-45; p < 0.05) and anthracyclines exposure (HR = 1.3; CI 1.2-26; p < 0.05) significantly predicted obesity. CONCLUSION: CCSs show a high and variable risk for developing dyslipidaemia and obesity, depending on cancer diagnosis and treatments. Therefore, they need accurate and tailored control of their cardiovascular risk profile.
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Felicetti et al. (2014) conducted a cohort in Childhood cancer (n=340). Total body irradiation vs. No total body irradiation was evaluated on Hypercholesterolaemia (total cholesterol >200 and/or LDL >160 mg/dl) (HR 2.7, 95% CI 1.2-4.4, p=<0.05). Total body irradiation significantly increased the risk of hypercholesterolaemia in childhood cancer survivors (HR 2.7; 95% CI 1.2-4.4; p<0.05).
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