Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Cancer Med. 2018 Sep;7(9):4801-4813. doi: 10.1002/cam4.1572. Epub 2018 Aug 15.
Cardiovascular disease has been identified as one of the late complications of cancer therapy. The purpose of this study was to quantify the long-term risk of cardiovascular mortality among lymphoma survivors relative to that of the general population. A systematic review and meta-analysis were conducted. Articles were identified in November 2016 by searching EMBASE, MEDLINE, and CINAHL databases. Observational studies were included if they assessed cardiovascular mortality in patients with lymphoma who survived for at least 5 years from time of diagnosis or if they had a median follow-up of 10 years. A pooled standardized mortality ratio (SMR) was estimated using a DerSimonian and Laird random-effects model. The Q and I statistics were used to assess heterogeneity. Funnel plots and Begg's and Egger's tests were used to evaluate publication bias. Of the 7450 articles screened, 27 studies were included in the systematic review representing 46 829 Hodgkin and 14 764 non-Hodgkin lymphoma survivors. The pooled number of deaths attributable to cardiovascular disease among Hodgkin and non-Hodgkin disease was estimated to be 7.31 (95% CI: 5.29-10.10; I = 95.4%) and 5.35 (95% CI: 2.55-11.24; I = 94.0%) times that of the general population, respectively. This association was greater among Hodgkin lymphoma survivors treated before the age of 21 (pooled SMR = 13.43; 95% CI: 9.22-19.57; I = 78.9%). There was a high degree of heterogeneity and a high risk of bias due to confounding in this body of literature. Lymphoma survivors have an increased risk of fatal cardiovascular events compared to the general population and should be targeted for cardiovascular screening and prevention campaigns.
心血管疾病已被确定为癌症治疗的晚期并发症之一。本研究的目的是量化淋巴瘤幸存者相对于一般人群的心血管死亡率的长期风险。进行了系统评价和荟萃分析。 2016 年 11 月，通过搜索 EMBASE、MEDLINE 和 CINAHL 数据库，确定了文章。如果评估了淋巴瘤患者的心血管死亡率，这些患者在诊断后至少 5 年存活，或者中位随访时间为 10 年，则纳入观察性研究。使用 DerSimonian 和 Laird 随机效应模型估计合并标准化死亡率比（SMR）。使用 Q 和 I 统计量评估异质性。漏斗图和 Begg 和 Egger 检验用于评估发表偏倚。在筛选的 7450 篇文章中，有 27 项研究被纳入系统评价，代表 46829 例霍奇金和 14764 例非霍奇金淋巴瘤幸存者。霍奇金病和非霍奇金病归因于心血管疾病的死亡人数估计分别为 7.31（95％CI：5.29-10.10; I = 95.4％）和 5.35（95％CI：2.55-11.24; I = 94.0％）。 21 岁以下接受治疗的霍奇金淋巴瘤幸存者的这种关联更大（合并 SMR = 13.43; 95％CI：9.22-19.57; I = 78.9％）。由于混杂因素，该文献存在高度异质性和高偏倚风险。与一般人群相比，淋巴瘤幸存者发生致命心血管事件的风险增加，应针对心血管筛查和预防活动进行靶向治疗。
