文章：

儿童癌症幸存者心脏毒性风险分层：最新综述与新型两步法策略

Risk Stratification for Cardiotoxicity in Childhood Cancer Survivors: State-of-the-Art Review and a Novel Two-Step Approach

原文发布日期：23 November 2025

DOI: 10.3390/cancers17233740

类型: Article

开放获取: 是

英文摘要：

Numerous studies and international recommendations have investigated risk factors that put childhood cancer survivors (CCSs) at a higher risk of late-onset cancer therapy-related cardiovascular toxicities (CTR-CVTs). While anthracyclines and chest-directed radiotherapy are well-established high-risk treatments, other anticancer therapies, including alkylating agents, antimetabolites, targeted therapies, and hematopoietic stem cell transplantation, also carry potential cardiotoxic effects. The likelihood of developing CTR-CVT is further modulated by the presence of cardiometabolic risk factors, prior occurrence of CTR-CVT during treatment, and certain clinical conditions, which may predispose survivors to long-term cardiovascular complications. This state-of-the-art review summarizes current strategies for stratifying the risk for developing CTR-CVT in CCSs. We then propose a tailored, multimodal approach for guiding cardio-oncological assessments both during treatment and in long-term follow-up, including a structured echocardiographic protocol. Future perspectives include validation of this approach to optimize early detection and personalized management of CTR-CVT.

摘要翻译： 

大量研究与国际指南已深入探讨了导致儿童癌症幸存者（CCSs）更易发生迟发性癌症治疗相关心血管毒性（CTR-CVTs）的风险因素。尽管蒽环类药物和胸部定向放疗已被确认为高风险治疗手段，其他抗癌疗法——包括烷化剂、抗代谢药物、靶向治疗及造血干细胞移植——同样存在潜在心脏毒性。CTR-CVT的发生风险还受到心脏代谢危险因素、治疗期间曾发生CTR-CVT以及特定临床状况的进一步影响，这些因素可能使幸存者更易出现长期心血管并发症。本前沿综述系统梳理了当前针对CCSs发生CTR-CVT的风险分层策略，进而提出一种个体化、多模式的诊疗路径，用于指导治疗期间及长期随访中的心脏肿瘤学评估，包括规范化的超声心动图检查方案。未来展望包括验证该路径以优化CTR-CVT的早期检测与个体化管理。

原文链接：

Risk Stratification for Cardiotoxicity in Childhood Cancer Survivors: State-of-the-Art Review and a Novel Two-Step Approach