1 Non-Communicable Diseases Epidemiology London School of Hygiene and Tropical Medicine London United Kingdom.
2 Department of Clinical Epidemiology Institute of Clinical Medicine Aarhus University Hospital Aarhus N Denmark.
J Am Heart Assoc. 2018 Aug 21;7(16):e009428. doi: 10.1161/JAHA.118.009428.
Background We aimed to examine whether acute pericarditis is an indicator of undetected cancer and identify patient-level factors associated with high cancer risk among patients presenting with pericarditis. Methods and Results A population-based matched cohort study was conducted using primary care data from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients with acute pericarditis (n=6530) were matched to a comparison cohort (n=26 111) on age, sex, calendar time, and general practice. We estimated cumulative cancer incidences, and calculated hazard ratios using Cox regression. Effect modification by patients' characteristics and lifestyle factors was examined, and we fitted a parsimonious model to evaluate absolute excess risk of later cancer among pericarditis patients by key patient-level factors. We identified 728 and 1379 incidents of cancer among pericarditis patients and the comparison cohort (median follow-up, 2.8 and 3.5 years). Pericarditis was associated with an elevated subsequent risk of any cancer (hazard ratio=3.03; 95% confidence interval, 2.74-3.36). The association was particularly pronounced 0 to 3 months after pericarditis (hazard ratio=23.56; 95% confidence interval, 18.00-30.83), but a more-modest association remained thereafter (hazard ratio=1.95; 95% confidence interval, 1.48-2.57 after 3-12 months, and hazard ratio=1.40; 95% confidence interval, 1.21-1.62 after >12 month). Older individuals hospitalized with pericarditis and with combinations of obesity and smoking were at the highest excess risk of having a cancer diagnosis 3 to 12 months later, reaching 4.8%. Conclusions Occult cancers may be going undiagnosed during the acute episode of pericarditis. Patients presenting with pericarditis and combinations of older age, obesity, smoking, and a need for hospitalization might warrant targeted investigations for cancer.
背景 我们旨在研究急性心包炎是否是隐匿性癌症的标志物，并确定在心包炎患者中与高癌症风险相关的患者水平因素。
方法和结果 采用基于人群的匹配队列研究，使用来自英国临床实践研究数据链接（与医院事件统计数据相关）的初级保健数据。将急性心包炎患者（n=6530）与对照队列（n=26111）按年龄、性别、日历时间和全科医生进行匹配。我们估计了累积癌症发生率，并使用 Cox 回归计算了风险比。通过患者特征和生活方式因素检查了效应修饰，并拟合了一个简约模型，以根据关键患者水平因素评估心包炎患者中晚期癌症的绝对超额风险。我们在心包炎患者和对照组中分别确定了 728 例和 1379 例癌症事件（中位随访时间为 2.8 年和 3.5 年）。心包炎与随后发生任何癌症的风险增加相关（风险比=3.03；95%置信区间，2.74-3.36）。这种关联在心包炎发生后 0 至 3 个月时尤为明显（风险比=23.56；95%置信区间，18.00-30.83），但此后仍存在更为适度的关联（心包炎发生后 3-12 个月风险比=1.95；95%置信区间，1.48-2.57，心包炎发生后>12 个月风险比=1.40；95%置信区间，1.21-1.62）。因心包炎住院的年龄较大的个体以及肥胖和吸烟组合的个体，在 3 至 12 个月后被诊断出癌症的风险最高，达到 4.8%。
结论 隐匿性癌症可能在急性心包炎发作期间未被诊断。出现心包炎并伴有年龄较大、肥胖、吸烟和需要住院等因素的患者可能需要针对癌症进行有针对性的检查。
