Table 1.
Characteristics of the CCS in the Derivation and Validation Cohort
| Derivation Cohort: Amsterdam (n = 299) | Validation Cohort: Nijmegen (n = 218) | p Value | |
|---|---|---|---|
| Female | 168 (56.2) | 109 (50.0) | 0.192 |
| Age at cancer diagnosis, yrs | 7.22 (4.01–11.71) | 7.02 (4.00–12.46) | 0.625 |
| Time since cancer diagnosis at first follow-up echo, yrs | 16.74 (11.83–23.15) | 16.95 (12.99–21.70) | 0.512 |
| Age at first follow-up echo, yrs | 24.06 (19.60–30.71) | 22.63 (20.05–28.06) | 0.399 |
| Tumor | <0.001 | ||
| ALL | 55 (18.4) | 71 (32.6) | |
| AML | 14 (4.7) | 15 (6.9) | |
| Hodgkin lymphoma | 23 (7.7) | 30 (13.8) | |
| Non-Hodgkin lymphoma | 61 (20.4) | 37 (17.0) | |
| Nephroblastoma | 46 (15.4) | 14 (6.4) | |
| Soft-tissue sarcoma | 28 (9.4) | 7 (3.2) | |
| Ewing sarcoma | 18 (6.0) | 14 (6.4) | |
| Osteosarcoma | 24 (8.0) | 13 (6.0) | |
| CNS tumor | 17 (5.7) | 4 (1.8) | |
| Germ cell tumor | 4 (1.3) | 1 (0.5) | |
| Neuroblastoma | 2 (0.7) | 9 (4.1) | |
| Other | 7 (2.3) | 2 (0.9) | |
| Anthracyclines | 239 (79.9) | 214 (98.2) | <0.001 |
| Cumulative anthracycline dose, mg/m2 | 280.0 (180.0–400.0) | 180.0 (150.0–301.4) | <0.001 |
| Chest RT | 105 (35.1) | 59 (27.1) | 0.065 |
| Chest RT dose, Gy | 25.0 (18.0–33.3) | 20.0 (18.0–30.0) | 0.406 |
| Anthracyclines and chest RT | 45 (15.1) | 56 (25.7) | 0.004 |
| Mitoxantrone | 12 (4.0) | 7 (4.2) | 1.000 |
| Cumulative mitoxantrone dose, mg/m2 | 12.0 (12.0–16.0) | 40.0 (20.0–40.0) | 0.003 |
| EF at first follow-up echo | 57.1 ± 6.9 | 61.6 ± 7.1 | <0.001 |
| EF 40%–49% at first follow-up echo | 41 (13.7) | 12 (5.5) | 0.004 |
| Hypertension | 15 (5.0) | — | |
| Dyslipidemia | 4 (1.34) | — | |
| Diabetes mellitus | 2 (0.7) | — | |
| Heart failure medication(s) use at first echo | 4 (1.3) | 3 (1.4) | 1.000 |
| Follow-up after the first follow-up echo, yrs | 10.90 (8.19–13.05) | 8.86 (5.22–10.86) | <0.001 |
| Number of follow-up echoes per patient | 5 (3–6) | 3 (2–4) | <0.001 |
| Echocardiographic surveillance rate, per 5 yrs | 2.26 (1.96–2.67) | 1.93 (1.57–2.52) | <0.001 |
| Left ventricular dysfunction with EF <40% during follow-up | 11 (3.7) | 7 (3.2) | 0.965 |
Values are n (%), median (25th to 75th percentile), or mean ± SD.
ALL = acute lymphocytic leukemia; AML = acute myeloid leukemia; chest RT = chest-directed radiotherapy; CNS = central nervous system; Gy = gray.