JNCI Cancer Spectr. 2026 Oct 30:pkag118. doi: 10.1093/jncics/pkag118. Online ahead of print.
ABSTRACT
BACKGROUND: Survivors of childhood cancer (CCS) have higher risk of developing ischaemic heart disease (IHD), however, data on coronary anatomy, revascularisations, and prognosis remain limited. The objective was to investigate angiographic findings, invasive treatment patterns and mortality in CCS with IHD compared with controls without a history of childhood cancer.
METHODS: This was a nationwide retrospective cohort-study of all 5-year survivors of leukaemia, lymphoma, or central nervous system cancer who subsequently developed IHD, with index cancer between 1958-2021. CCS were compared with population-based controls with IHD matched on cancer date by age, sex and residence.
RESULTS: 136 CCS and 667 controls with IHD were included. CCS were a median of 5.2 years younger than controls at diagnosis of IHD. CCS had a higher prevalence of left main coronary artery (LMCA) stenosis (25.0% vs. 6.5%; p < 0.001) and multivessel disease (51.2% vs. 39.4%; p = 0.043). Coronary artery bypass grafting (CABG) was more frequently performed in CCS (22.8% vs. 11.4%; p < 0.001), although after adjusting for relevant covariates the difference was attenuated. After a median follow-up of 5.4 years following IHD diagnosis, CCS had higher hazard of all-cause mortality (HR 1.83, 95% CI 1.31-2.54; p < 0.001) and cardiovascular mortality (HR 2.04; 95% CI 1.42-2.95; p < 0.001).
CONCLUSIONS: CCS who developed IHD demonstrate a higher burden of extensive coronary artery disease, characterized by increased prevalence of LMCA stenosis and multivessel disease. Although overall revascularisation rates were similar, CCS experienced significantly higher all-cause and cardiovascular mortality following IHD-diagnosis compared with controls.
PMID:42960909 | DOI:10.1093/jncics/pkag118