Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Cardiology Department, Carmel Medical Center, Haifa, Israel.
Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.
JACC Cardiovasc Interv. 2019 Jan 14;12(1):78-86. doi: 10.1016/j.jcin.2018.10.026.
The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS).
Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option.
A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias.
Cancer patients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients.
TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997).
作者旨在收集关于接受经导管主动脉瓣置换术（TAVR）治疗的严重主动脉瓣狭窄（AS）合并恶性肿瘤患者的当代治疗方法和结局的数据。
患有严重 AS 的肿瘤患者通常被排除在瓣膜置换手术之外。TAVR 可能是一种新兴的治疗选择。
设计了一项全球性注册研究，以收集正在接受 TAVR 治疗且合并活动性恶性肿瘤的患者数据。来自 18 个 TAVR 中心的 222 名癌症患者的数据与来自 5 个参与中心的 2522 名“无癌症”患者进行了比较。采用倾向评分匹配进一步调整偏倚。
癌症患者的年龄为 78.8 ± 7.5 岁，STS 评分 4.9 ± 3.4%，62%为男性。最常见的癌症为胃肠道（22%）、前列腺（16%）、乳腺（15%）、血液（15%）和肺部（11%）。在 TAVR 时，40%的患者处于癌症 4 期。两组患者的围手术期并发症相似。尽管 30 天死亡率相似，但癌症患者的 1 年死亡率更高（15%比 9%；p<0.001）；一半的死亡归因于肿瘤。在 TAVR 后存活 1 年的患者中，有三分之一的癌症已缓解/治愈。恶性肿瘤进展（III 期至 IV 期）是死亡的强烈预测因素（风险比：2.37；95%置信区间：1.74 至 3.23；p<0.001），而与无癌症患者相比，I 期至 II 期癌症与更高的死亡率无关。
与无癌症患者相比，TAVR 治疗癌症患者的短期预后相似，但长期预后较差。在该队列中，死亡率主要由癌症驱动，恶性肿瘤进展是死亡的强烈预测因素。重要的是，85%的患者在 1 年内存活，三分之一的患者癌症缓解/治愈。（肿瘤患者行经导管主动脉瓣植入术的结局[TOP-AS]；NCT03181997）。
