Peak oxygen uptake impairment in childhood cancer survivors treated with anthracycline-based chemotherapy: a systematic-review and meta-analysis
Notice bibliographique
Résumé
Abstract Background Exposure to cardiotoxic therapies such as anthracycline chemotherapy places childhood cancer survivors (CCS) at markedly increased risk of heart failure and cardiovascular mortality. Peak oxygen uptake (VO2peak) is an objective marker of cardiovascular function that is a strong predictor of incident heart failure and cardiovascular mortality. However, the degree of VO2peak impairment in CCS is yet to be definitively established. Purpose To perform a systematic review and meta-analysis comparing VO2peak and cardiac function in CCS treated with anthracycline chemotherapy versus age-matched non-cancer controls (CON). Methods A systematic search was performed using Embase, Scopus, MEDLINE, CINAHL and SPORTDiscus databases to identify cross-sectional studies comparing VO2peak (primary outcome) and resting cardiac function in CCS versus CON. Studies were included if i) participants were childhood cancer survivors (≤18 years old when cancer was diagnosed) exposed to anthracycline-based chemotherapy; ii) assessments were performed after completing adjuvant therapy; iii) reported VO2peak assessed from a maximal exercise test with expired gas analysis. Studies were excluded if they i) reported no original data; ii) did not include a healthy non-cancer control group; iii) reported duplicate data; iv) were not available in English. Values for CCS and CON were compared using a fixed-effects model, with results reported as weighted mean differences (WMD) with 95% confidence interval (95% CI) for the difference between CCS relative to CON. Heterogeneity was determined using the I2 statistic. Results 2026 studies were identified, of which 18 unique case-control studies reporting peak VO2 in CCS (n=786, 44% female, mean age: 16 yrs, mean time post-therapy: 2.7 yrs) and CON (n=1379, 50% female, mean age: 16 yrs) were included in the meta-analysis. Childhood cancer survivors had markedly lower VO2peak (WMD: -7.08 mL/kg/min; 95% CI: -7.75 to -6.42, I2: 79%). Resting left-ventricular ejection fraction (LVEF) was the only measure of cardiac function with a sufficient number of studies for meta-analysis (n=5 studies). In contrast to VO2peak, there was only a small decrement in resting LVEF (WMD: -1.6%; 95% CI: -2.6 to -0.6; I2: 49%), and the mean resting LVEF for CCS was in the normal range in all studies (Range: 61.4% to 72.0%). Conclusion Despite negligible differences in resting cardiac function, CCS have a marked reduction in VO2peak that may explain their increased risk of heart failure and cardiovascular mortality. Incorporating measures of VO2peak into cardiac surveillance may improve the identification of CCS at risk of future cardiovascular events who may benefit from therapies (eg. exercise-based cardiac rehabilitation) to address impairment in VO2peak. Figure 1Pooled results for VO2peak Figure 2Pooled results for resting LVEF
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».