Background: Research on cancer survivorship associated with nasopharyngeal carcinoma (NPC) is rare. We aimed to elucidate the risk of ischemic stroke in 5-year survivors of NPC following radiotherapy (RT) or concurrent chemoradiation therapy (CCRT).
Subjects, materials, and methods: NPC survivors, defined as those who survived longer than 5 years after diagnosis, were identified and matched at a 1:5 ratio with normal controls from the Longitudinal Health Insurance Database 2005 of Taiwan. The stratified Cox regression models were used to access the risk of ischemic stroke, with adjustment for age, treatment modality, comorbidities, and socioeconomic characteristics.
Results: From 2000 to 2005, a total of 3,016 NPC survivors who had received RT (n = 959) or CCRT (n = 2,057) and 15,080 controls were matched for age, sex, income, and urbanization level. The risk of ischemic stroke was significantly higher in the NPC survivor cohort than in the control cohort. Stroke was positively related to death. Moreover, the age onset of stroke for NPC survivors was 10 years earlier than that for the general population.
Conclusion: Not only was the stroke risk in NPC survivors higher than that in the general population, but the onset age was also 10 years earlier. Future survivorship care should include ischemic stroke as a late complication, for its proper prevention and management.
Implications for practice: Nasopharyngeal carcinoma (NPC) is endemic in Taiwan, and its 5-year survival is 65.2%. With the increased 5-year cancer survivors, survivorship has become an important issue. However, research on NPC survivorship is very rare. To the authors' knowledge, this is the first population-based study on long-term NPC survivors. This study's results indicated that not only was the risk of ischemic stroke in NPC survivors at least triple that of the general population, but the onset age was also 10 years earlier. These results may provide solid evidence that survivorship care guidelines should include stroke as a late complication in 5-year NPC survivors, for its proper prevention and management.
摘要
背景。有关鼻咽癌 (NPC) 癌症幸存者的研究并不多见。我们的目的在于阐明在接受放疗 (RT) 或同期放化疗 (CCRT) 后，5 年NPC幸存者患缺血性脑卒中的风险。
受试者、材料和方法。NPC幸存者的定义为自诊断后生存超过 5 年的患者，我们以 1:5 的比例与台湾 2005 年全民健康保险研究资料库提供的正常对照进行了鉴定和匹配。我们采用分层 Cox 回归模型获得了缺血性脑卒中的风险，并根据年龄、治疗方式、合并症和社会经济特征进行了校正。
结果。2000 年至 2005 年，我们共对 3 016 名接受过RT (n = 959) 或CCRT (n = 2 057) 的NPC幸存者按年龄、性别、收入和城市化水平与 15 080 名对照者进行了匹配。在NPC幸存者队列中，患缺血性脑卒中的风险明显高于对照组。脑卒中与死亡呈正相关。另外，NPC幸存者的脑卒中发病年龄比一般人群早 10 年。
结论。不仅NPC幸存者的脑卒中风险高于一般人群，发病年龄也比一般人群早 10 年。未来的幸存者医疗应将缺血性脑卒中作为晚期并发症纳入其中，以便进行适当的预防和管理。
实践意义:鼻咽癌 (NPC) 是台湾的地方病，5 年生存率为 65.2%。随着 5 年癌症幸存者数量的增加，癌症幸存者已成为一个重要问题。但是，对NPC幸存者的研究非常少见。据作者所知，这是首个针对长期NPC幸存者人群的研究。本研究的结果表明，不仅NPC幸存者患缺血性脑卒中的风险至少是一般人群的三倍，发病年龄也比一般人群早 10 年。这些结果可充分证明，应将脑卒中作为 5 年NPC幸存者的晚期并发症纳入幸存者医疗指南，以便进行适当的预防和管理。
Keywords: Nasopharyngeal carcinoma; Radiotherapy; Stroke; Survivorship.
© AlphaMed Press 2019.