童年癌症幸存者似乎存在易衰老和肌肉萎缩的风险，但是有关这些老年表型的发生和高危群体的证据很少，尤其是欧洲幸存者。这项横断面研究的目的是评估荷兰1963年至2001年被诊断患有儿童癌症幸存者的患者中，易衰老、衰老和肌肉萎缩的患病率并探索其风险因素。从荷兰儿童癌症幸存者研究（DCCSS-LATER）队列中的合格个体（在研究期间仍存活、居住在荷兰、年龄介于18-45岁之间，并且以前未拒绝参加后效研究）邀请参加本横断面研究。我们根据修正的 Fried 标准定义可疑易衰老和衰老，根据欧洲老年人肌肉萎缩工作组2标准定义肌肉萎缩。在任何衰老测量或完整的肌肉萎缩测量中，这些情况与人口统计学和治疗相关以及内分泌和生活方式相关因素之间的关联，通过两个单独的多变量逻辑回归模型进行估计。共邀请3996名荷兰DCCSS-LATER队列的成年幸存者参加本横断面研究。1993名未参与者因没有回应或拒绝参与而被排除，2003名（50·1%）年龄在18-45岁之间的儿童癌症幸存者被纳入研究。1114名（55·6%）参与者有完整的衰老测量结果，1472名（73·5%）参与者有完整的肌肉萎缩测量结果。参加者参与本研究时的平均年龄为33.1岁（标准差7.2）。1037名（51·8%）参与者为男性，966名（48.2%）为女性，没有变性人。在具有完整衰老测量或完整肌肉萎缩测量的幸存者中，可疑易衰老的百分比为20·3%（95% CI 18·0-22·7），衰老的百分比为7·4％（6·0-9·0），肌肉萎缩的百分比为4·4％（3・5-5·6）。对于预备易衰老的模型，认为男性（OR 4·56 [95%CI 2·26-9·17]）、低BMI（连续，OR 0.52 [0.45-0.60]）、头部放射治疗（OR 3·87 [1·80-8·31]）、全身放射治疗（OR 4.52 [1.67-12.20]）、性腺功能减退症（OR 3.96 [1.40-11.18]）、生长激素缺乏（OR 4.66 [1.44-15.15]）以及维生素B12缺乏（OR 6.26 [2.17-1.81]）是显著的。对于衰老，相关因素包括在10-18岁被诊断的年龄（OR 1.94 [95% CI 1.19-3.16]）、低体重（OR 3.09 [1.42-6.69]）、头部放射治疗（OR 2.65 [1.59-4.34]）、全身放射治疗（OR 3.28 [1.48-7.28]）、至少600mg /m²的顺铂剂量（OR 3.93 [1.45-10.67]）、更高的卡铂剂量（每g /m²；OR 1.15 [1.02-1.31]）、环磷酰胺当量剂量至少为20g/m²（OR 3.90 [1.65-9.24]）、甲状腺功能亢进（OR 2.87 [1.06-7.76]）、骨密度Z得分≤-2（OR 2.85 [1.54-5.29]）以及叶酸缺乏（OR 2.04 [1.20-3.46]）。本研究结果表明，易衰老和肌肉萎缩在幼年时期的癌症幸存者中已经发生，平均年龄为33岁。对内分泌疾病和饮食缺乏的早期识别和干预可能在最小化此人群的易衰老、衰老和肌肉萎缩风险方面非常重要。本研究得到儿童无癌症基金会、KiKaRoW、荷兰癌症协会、ODAS基金会的资助。版权 ©2023年作者。由Elsevier Ltd.出版。这是一篇按照CC BY-NC-ND 4.0许可证发布的开放获取文章。Elsevier Ltd.出版。版权所有。

Childhood cancer survivors appear to be at increased risk of frailty and sarcopenia, but evidence on the occurrence of and high-risk groups for these aging phenotypes is scarce, especially in European survivors. The aim of this cross-sectional study was to assess the prevalence of and explore risk factors for pre-frailty, frailty, and sarcopenia in a national cohort of Dutch childhood cancer survivors diagnosed between 1963 and 2001.Eligible individuals (alive at the time of study, living in the Netherlands, age 18-45 years, and had not previously declined to participate in a late-effects study) from the Dutch Childhood Cancer Survivor Study (DCCSS-LATER) cohort were invited to take part in this cross-sectional study. We defined pre-frailty and frailty according to modified Fried criteria, and sarcopenia according to the European Working Group on Sarcopenia in Older People 2 definition. Associations between these conditions and demographic and treatment-related as well as endocrine and lifestyle-related factors were estimated with two separate multivariable logistic regression models in survivors with any frailty measurement or complete sarcopenia measurements.3996 adult survivors of the DCCSS-LATER cohort were invited to participate in this cross-sectional study. 1993 non-participants were excluded due to lack of response or a decline to participate and 2003 (50·1%) childhood cancer survivors aged 18-45 years were included. 1114 (55·6%) participants had complete frailty measurements and 1472 (73·5%) participants had complete sarcopenia measurements. Mean age at participation was 33·1 years (SD  7·2). 1037 (51·8%) participants were male, 966 (48·2%) were female, and none were transgender. In survivors with complete frailty measurements or complete sarcopenia measurements, the percentage of pre-frailty was 20·3% (95% CI 18·0-22·7), frailty was 7·4% (6·0-9·0), and sarcopenia was 4·4% (3·5-5·6). In the models for pre-frailty, underweight (odds ratio [OR] 3·38 [95% CI 1·92-5·95]) and obesity (OR 1·67 [1·14-2·43]), cranial irradiation (OR 2·07 [1·47-2·93]), total body irradiation (OR 3·17 [1·77-5·70]), cisplatin dose of at least 600 mg/m2 (OR 3·75 [1·82-7·74]), growth hormone deficiency (OR 2·25 [1·23-4·09]), hyperthyroidism (OR 3·72 [1·63-8·47]), bone mineral density (Z score ≤-1 and >-2, OR 1·80 [95% CI 1·31-2·47]; Z score ≤-2, OR 3·37 [2·20-5·15]), and folic acid deficiency (OR 1·87 [1·31-2·68]) were considered significant. For frailty, associated factors included age at diagnosis between 10-18 years (OR 1·94 [95% CI 1·19-3·16]), underweight (OR 3·09 [1·42-6·69]), cranial irradiation (OR 2·65 [1·59-4·34]), total body irradiation (OR 3·28 [1·48-7·28]), cisplatin dose of at least 600 mg/m2 (OR 3·93 [1·45-10·67]), higher carboplatin doses (per g/m2; OR 1·15 [1·02-1·31]), cyclophosphamide equivalent dose of at least 20 g/m2 (OR 3·90 [1·65-9·24]), hyperthyroidism (OR 2·87 [1·06-7·76]), bone mineral density Z score ≤-2 (OR 2·85 [1·54-5·29]), and folic acid deficiency (OR 2·04 [1·20-3·46]). Male sex (OR 4·56 [95%CI 2·26-9·17]), lower BMI (continuous, OR 0·52 [0·45-0·60]), cranial irradiation (OR 3·87 [1·80-8·31]), total body irradiation (OR 4·52 [1·67-12·20]), hypogonadism (OR 3·96 [1·40-11·18]), growth hormone deficiency (OR 4·66 [1·44-15·15]), and vitamin B12 deficiency (OR 6·26 [2·17-1·81]) were significantly associated with sarcopenia.Our findings show that frailty and sarcopenia occur already at a mean age of 33 years in childhood cancer survivors. Early recognition and interventions for endocrine disorders and dietary deficiencies could be important in minimising the risk of pre-frailty, frailty, and sarcopenia in this population.Children Cancer-free Foundation, KiKaRoW, Dutch Cancer Society, ODAS Foundation.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.