Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Catheter Cardiovasc Interv. 2019 Sep 1;94(3):438-445. doi: 10.1002/ccd.28052. Epub 2018 Dec 14.
We compared the outcomes of aortic valve replacement (AVR) by transcatheter (TAVR) and surgical (SAVR) routes with those of optimal medical management in patients with cancer and severe aortic stenosis (AS).
Cancer therapy requires optimal cardiac output; however, the treatment of AS in cancer patients is not established.
Cancer patients with severe AS during January 2009 through February 2018 at a large cancer center were identified. Demographic and clinical characteristics including previous or active cancer diagnosis, history of chest radiotherapy, AS treatment, and survival were collected. Univariate Cox proportional hazards regression, the Kaplan-Meier analysis, and log-rank tests were used to compare overall survival (OS) between AS treatment groups.
Sixty-five cancer patients with severe AS were identified; 28 received optimal medical treatment alone, 30 received TAVR, and seven received SAVR. The patients were predominantly male (n = 44, 68%) with a mean age of 71.17 years. The median OS was 9.87 months, and the most common cause of death was cancer (n = 29, 94% of deaths). AVR was associated with a lower risk of death than no AVR (hazard ratio [HR] 0.38, P = 0.007), and patients who underwent TAVR (HR 0.36, P = 0.01) had better survival than those with no AVR. Malignancy type, stage, and treatment were not associated with OS.
Patients with cancer and severe AS who underwent AVR, predominantly TAVR, experienced better survival than those who had no AVR regardless of cancer type or cancer treatment. TAVR may be considered in patients with cancer and AS.
我们比较了经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）与癌症合并重度主动脉瓣狭窄（AS）患者最佳药物治疗的结局。
癌症治疗需要最佳的心输出量；然而，癌症患者 AS 的治疗尚未确定。
在一家大型癌症中心，2009 年 1 月至 2018 年 2 月期间，确定了患有严重 AS 的癌症患者。收集了人口统计学和临床特征，包括既往或现患癌症诊断、胸部放疗史、AS 治疗和生存情况。采用单因素 Cox 比例风险回归、Kaplan-Meier 分析和对数秩检验比较 AS 治疗组的总生存率（OS）。
确定了 65 例患有严重 AS 的癌症患者；28 例单独接受最佳药物治疗，30 例接受 TAVR，7 例接受 SAVR。患者主要为男性（n=44，68%），平均年龄为 71.17 岁。中位 OS 为 9.87 个月，最常见的死亡原因为癌症（n=29，94%的死亡）。与未行 AVR 相比，行 AVR 与较低的死亡风险相关（风险比[HR]0.38，P=0.007），且行 TAVR（HR 0.36，P=0.01）的患者生存情况优于未行 AVR 的患者。恶性肿瘤类型、分期和治疗与 OS 无关。
患有癌症和重度 AS 的患者接受了 AVR，主要是 TAVR，其生存情况优于未行 AVR 的患者，无论癌症类型或癌症治疗如何。TAVR 可考虑用于癌症合并 AS 的患者。
