英国伦敦卫生与热带医学院Krishnan Bhaskaran课题组分析了20种成人癌症幸存者特定心血管疾病的中长期风险：基于人群的队列研究。相关论文在线发表于2019年8月20日的《柳叶刀》上。

在过去的几十年里，癌症的存活率有了很大的提高，但是对幸存者长期心血管疾病风险的担忧仍然存在。在各种癌症的幸存者中，缺乏关于特定心血管疾病风险的证据，无法进行预防和管理。

这项以人群为基础的队列研究采集英国临床实践研究数据链中的相关初始治疗、住院和癌症登记数据，来建立20种最常见癌症的幸存者队列，所有患者年龄均在18岁及以上，经诊断控制后无癌生存超过12个月。年龄、性别和一般资料无显著性差异。课题组人员采用粗略校正过的Cox模型对一系列心血管疾病的风险进行比较。

从1990年1月1日至2015年12月31日，126120例确诊癌症的患者至少被随访一年，对照组630144例。经排除，主要分析108215名癌症幸存者和523541名对照者。与对照组相比，20种特定部位癌症的幸存者中有18种患静脉血栓栓塞的风险升高，其中前列腺癌患者的风险比最低（1.72），胰腺癌患者的风险比最高（9.72）。随着时间的推移，该风险比有所降低，但在确诊5年后依然存在。研究组观察到20种癌症幸存者中有10种患心力衰竭和心肌病的风险升高，包括血癌（非霍奇金淋巴瘤的风险比为1.94，白血病为1.77，多发性骨髓瘤为3.29），食道癌（1.96），肺癌（1.82），肾癌（1.73），和卵巢癌（1.59）等。在多种癌症包括血液学恶性肿瘤的患者中，心律失常、心包炎、冠状动脉疾病、中风和瓣膜心脏病的患病风险升高。既往无心血管疾病的患者和年轻患者中，心衰、心肌病和静脉血栓栓塞的风险比更高。然而，绝对超额风险通常随着年龄的增长而增加。在接受化疗的患者中，这些风险似乎增加得最明显。

综上，与普通人群相比，大多数特定部位癌症的幸存者罹患一种或多种心血管疾病的中长期风险有所增加，但不同部位癌症之间存在显著差异。

附：英文原文

Title: Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases

Author: Helen Strongman, Sarah Gadd, Anthony Matthews, Kathryn E Mansfield, Susannah Stanway, Alexander R Lyon, Isabel dos-Santos-Silva, Liam Smeeth, Krishnan Bhaskaran

Issue&Volume: 20 August 2019

Abstract:

Background

The past few decades have seen substantial improvements in cancer survival, but concerns exist about long-term cardiovascular disease risk in survivors. Evidence is scarce on the risks of specific cardiovascular diseases in survivors of a wide range of cancers to inform prevention and management. In this study, we used large-scale electronic health records data from multiple linked UK databases to address these evidence gaps.

Methods

For this population-based cohort study, we used linked primary care, hospital, and cancer registry data from the UK Clinical Practice Research Datalink to identify cohorts of survivors of the 20 most common cancers who were 18 years or older and alive 12 months after diagnosis and controls without history of cancer, matched for age, sex, and general practice. We compared risks for a range of cardiovascular disease outcomes using crude and adjusted Cox models. We fitted interactions to investigate effect modification, and flexible parametric survival models to estimate absolute excess risks over time.

Findings

Between Jan 1, 1990, and Dec 31, 2015, 126?120 individuals with a diagnosis of a cancer of interest still being followed up at least 1 year later were identified and matched to 630?144 controls. After exclusions, 108?215 cancer survivors and 523?541 controls were included in the main analyses. Venous thromboembolism risk was elevated in survivors of 18 of 20 site-specific cancers compared with that of controls; adjusted hazard ratios (HRs) ranged from 1·72 (95% CI 1·57–1·89) in patients after prostate cancer to 9·72 (5·50–17·18) after pancreatic cancer. HRs decreased over time, but remained elevated more than 5 years after diagnosis. We observed increased risks of heart failure or cardiomyopathy in patients after ten of 20 cancers, including haematological (adjusted HR 1·94, 1·66–2·25, with non-Hodgkin lymphoma; 1·77, 1·50–2·09, with leukaemia; and 3·29, 2·59–4·18, with multiple myeloma), oesophageal (1·96, 1·46–2·64), lung (1·82, 1·52–2·17) kidney (1·73, 1·38–2·17) and ovarian (1·59, 1·19–2·12). Elevated risks of arrhythmia, pericarditis, coronary artery disease, stroke, and valvular heart disease were also observed for multiple cancers, including haematological malignancies. HRs for heart failure or cardiomyopathy and venous thromboembolism were greater in patients without previous cardiovascular disease and in younger patients. However, absolute excess risks were generally greater with increasing age. Increased risks of these outcomes seemed most pronounced in patients who had received chemotherapy.

Interpretation

Survivors of most site-specific cancers had increased medium-term to long-term risk for one or more cardiovascular diseases compared with that for the general population, with substantial variations between cancer sites.

DOI: https://doi.org/10.1016/S0140-6736(19)31674-5

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31674-5/fulltext