Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
Eur Heart J Qual Care Clin Outcomes. 2018 Jul 1;4(3):180-188. doi: 10.1093/ehjqcco/qcy010.
To investigate the effect of malignancy on the outcomes of patients with severe aortic stenosis (AS) and the management strategy for AS with malignancy.
Using data of 3815 patients with severe AS in a retrospective multicentre registry [CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry], we compared 3-year clinical outcomes among three groups based on malignancy status: with malignancy currently under treatment including best supportive care (malignancy group), with a history of malignancy without any current treatment (past history group), or without history of malignancy (no malignancy group). Patients in the malignancy group (n = 124) were more often men and had higher prevalence of low body mass index, recurrence of malignancy, anaemia, and asymptomatic status, despite comparable surgical risks and echocardiographic parameters. The malignancy group or the past history group (n = 389) had significantly higher risk for all-cause death [hazard ratio (HR) 2.49, 95% CI (95% confidence interval) 1.98-3.14; HR 1.23, 95% CI 1.04-1.46] and for malignancy-related death (HR 16.2, 95% CI 10.64-24.54; HR 3.66, 95% CI 2.43-5.52) than that of the no malignancy group (n = 3302). The excess risk for aortic valve-related death was not observed in the malignancy group (HR 0.79, 95% CI 0.48-1.29) and was lower in the past history group (HR 0.72, 95% CI 0.53-0.96). In the malignancy group, the treatment strategy (surgery: n = 16, conservative management: n = 108) was determined based on the clinical status of AS or life expectancy.
Malignancy had marked effect on all-cause death and malignancy-related death in patients with severe AS. History of malignancy also had a smaller but significant effect on mortality.
探讨恶性肿瘤对重度主动脉瓣狭窄（AS）患者结局的影响，以及恶性肿瘤合并 AS 的治疗策略。
利用回顾性多中心登记研究[CURRENT AS（主动脉瓣狭窄患者手术后和药物治疗的当代结局）登记研究]中 3815 例重度 AS 患者的数据，我们根据恶性肿瘤状态将患者分为三组，比较三组患者 3 年的临床结局：目前正在接受恶性肿瘤治疗（包括最佳支持治疗）的患者（恶性肿瘤组）；既往有恶性肿瘤病史但目前无治疗的患者（既往病史组）；无恶性肿瘤病史的患者（无恶性肿瘤组）。恶性肿瘤组（n=124）患者多为男性，体重指数较低、恶性肿瘤复发、贫血和无症状状态的发生率较高，尽管手术风险和超声心动图参数相似。恶性肿瘤组或既往病史组（n=389）的全因死亡风险[风险比（HR）2.49，95%置信区间（95%CI）为 1.98-3.14；HR 1.23，95%CI 为 1.04-1.46]和恶性肿瘤相关死亡风险[HR 16.2，95%CI 为 10.64-24.54；HR 3.66，95%CI 为 2.43-5.52]均显著高于无恶性肿瘤组（n=3302）。恶性肿瘤组主动脉瓣相关死亡的风险未见增加（HR 0.79，95%CI 为 0.48-1.29），而既往病史组则降低（HR 0.72，95%CI 为 0.53-0.96）。在恶性肿瘤组中，治疗策略（手术：n=16，保守治疗：n=108）根据 AS 的临床状况或预期寿命确定。
恶性肿瘤对重度 AS 患者的全因死亡和恶性肿瘤相关死亡有显著影响。既往恶性肿瘤病史对死亡率也有较小但有意义的影响。
