Background: Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended. Objectives: This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group. Methods: Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use. Results: Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22–4.28] for having a CACS > 0 compared to the matched population (p= 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population (p =0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively,p= 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population. Conclusion: In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group.
背景：胸部放疗是霍奇金淋巴瘤（HL）治疗的基石之一，但会增加心血管事件风险。由于HL常在年轻时期确诊，建议进行包括冠状动脉疾病（CAD）筛查在内的长期随访。目的：本研究旨在评估接受胸部放疗的HL患者与非癌症对照组相比，其冠状动脉钙化积分（CACS）与心血管事件的相关性。方法：纳入连续收治的HL患者，这些患者在胸部放疗10年后接受冠状动脉CT血管造影进行无症状CAD评估。研究人群包括97例HL患者，并按性别、年龄、心血管危险因素和他汀类药物使用情况与97例非癌症患者进行匹配。结果：HL人群接受CT检查时的平均年龄为45.5±9.9岁，非癌症人群为45.5±10.3岁。49例（50.5%）HL患者和30例（30.9%）对照患者的CACS升高（定义为>0）。与匹配人群相比，HL幸存者CACS>0的比值比为2.28[95% CI: 1.22–4.28]（p=0.006）。CACS>第90百分位数的患病率差异显著：HL幸存者为17.1%，匹配人群为4.6%（p=0.009）。非阻塞性冠状动脉狭窄在HL人群中的患病率高于对照组（分别为45.7% vs. 28.4%，p=0.01）。在8.5[5.3; 9.9]年的随访期间，9例HL患者发生心血管事件，其中2例患者CACS为零。对照组未发生任何事件。结论：在匹配研究人群中，与非癌症对照组相比，HL幸存者在胸部放疗后CACS>0的患病率更高，心血管事件风险增加。
肿瘤(癌症)患者之家