Previous efforts to predict absolute risk of treatment-related cardiovascular diseases (CVDs) have mostly focused on childhood cancer survivors. We aimed to develop prediction models for risk of coronary heart disease (CHD) and heart failure (HF) for survivors of adolescent/adult Hodgkin lymphoma (HL).

For model development, we used a multicenter cohort including 1,433 5-year HL survivors treated between 1965 and 2000 and age 18-50 years at HL diagnosis, with complete data on administered chemotherapy regimens, radiotherapy volumes and doses, and cardiovascular follow-up. Using cause-specific hazard models, covariate-adjusted cumulative incidences for CHD and HF were estimated in the presence of competing risks of death because of other causes than CHD and HF. Age at HL diagnosis, sex, smoking status, radiotherapy, and anthracycline treatment were included as predictors. External validation for the CHD model was performed using a Canadian cohort of 708 HL survivors treated between 1988 and 2004 and age 18-50 years at HL diagnosis.

After a median follow-up of 24 years, 341 survivors had developed CHD and 102 had HF. We were able to predict CHD and HF risk at 20 and 30 years after treatment with moderate to good overall calibration and moderate discrimination (areas under the curve: 0.68-0.74), which was confirmed by external validation for the CHD model (areas under the curve: 0.73-0.74). On the basis of our model including prescribed mediastinal radiation dose, 30-year risks ranged from 4% to 78% for CHD and 3% to 46% for HF, depending on risk factors.

We developed and validated prediction models for CHD and HF with good overall calibration and moderate discrimination. These models can be used to identify HL survivors who might benefit from targeted screening for CVD and early treatment for CVD risk factors.

以前预测治疗相关心血管疾病 (CVD) 绝对风险的努力主要集中在儿童癌症幸存者身上。我们旨在为青少年/成人霍奇金淋巴瘤 (HL) 幸存者开发冠心病 (CHD) 和心力衰竭 (HF) 风险的预测模型。

对于模型开发，我们使用了一个多中心队列，包括 1,433 名 5 年 HL 幸存者，这些幸存者在 1965 年至 2000 年之间接受治疗，诊断为 HL 时年龄在 18-50 岁之间，具有有关化疗方案、放疗量和剂量以及心血管随访的完整数据。使用特定原因的风险模型，在存在因 CHD 和 HF 以外的其他原因导致的死亡竞争风险的情况下，估计了 CHD 和 HF 的协变量调整累积发病率。HL 诊断时的年龄、性别、吸烟状况、放疗和蒽环类药物治疗被列为预测因素。CHD 模型的外部验证是使用加拿大 708 名 HL 幸存者队列进行的，这些幸存者在 1988 年至 2004 年间接受治疗，HL 诊断时年龄在 18-50 岁之间。

中位随访 24 年后，341 名幸存者患上了冠心病，102 名幸存者患上了心衰。我们能够预测治疗后 20 年和 30 年的 CHD 和 HF 风险，具有中等至良好的整体校准和中等歧视（曲线下面积：0.68-0.74），这已通过 CHD 模型的外部验证（曲线下面积）得到证实曲线：0.73-0.74）。根据我们的模型，包括规定的纵隔辐射剂量，CHD 的 30 年风险范围为 4% 至 78%，HF 的风险范围为 3% 至 46%，具体取决于风险因素。

我们开发并验证了 CHD 和 HF 的预测模型，具有良好的整体校准和适度的歧视。这些模型可用于识别可能受益于 CVD 靶向筛查和 CVD 危险因素早期治疗的 HL 幸存者。