Ahn Sanghyun, Min Jin-Young, Kim Hyunyoung G, Mo Hyejin, Min Seung-Kee, Min Sangil, Ha Jongwon, Min Kyoung-Bok
Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
BMC Surg. 2020 May 1;20(1):85. doi: 10.1186/s12893-020-00754-3.
Synchronous cancer in patients with abdominal aortic aneurysm (AAA) increases morbidity and mortality after AAA repair. However, little is known about the impact of the history of cancer on mortality after AAA repair.
Patients with intact AAA who were treated with endovascular aneurysm repair or open surgical repair were selected from the Health Insurance and Review Assessment data in South Korea between 2007 and 2016. Primary endpoints included the 30- and 90-day mortality and long-term mortality after AAA repair. The Cox proportional hazards models were constructed to evaluate independent predictors of mortality.
A total of 1999 patients (17.0%, 1999/11785) were diagnosed with cancer prior to the AAA repair. History of cancer generally had no effect in short-term mortality at 30 and 90 days. However, short-term mortality rate of patients with a history of lung cancer was more than twice that of patients without it (3.07% vs. 1.06%, P = 0.0038, 6.14% vs. 2.69%, P = 0.0016). Furthermore, the mortality rate at the end of the study period was significantly higher in AAA patients with a history of cancer than in those without a history of cancer (21.21% vs. 17.08%, P < .0001, HR, 1.31, 95% CI, 1.17-1.46).
The history of cancer in AAA patients increases long-term mortality but does not affect short-term mortality after AAA repair. However, AAA repair could increase both short- and long-term mortality in patients with lung cancer history, and those cases should be more carefully selected.
腹主动脉瘤（AAA）患者的同步癌会增加AAA修复术后的发病率和死亡率。然而，关于癌症病史对AAA修复术后死亡率的影响知之甚少。
从2007年至2016年韩国健康保险审查评估数据中选取接受血管内动脉瘤修复或开放手术修复的AAA完整患者。主要终点包括AAA修复术后30天和90天死亡率以及长期死亡率。构建Cox比例风险模型以评估死亡率的独立预测因素。
共有1999例患者（17.0%，1999/11785）在AAA修复术前被诊断患有癌症。癌症病史一般对30天和90天的短期死亡率没有影响。然而，有肺癌病史的患者短期死亡率是无肺癌病史患者的两倍多（3.07%对1.06%，P = 0.0038；6.14%对2.69%，P = 0.0016）。此外，有癌症病史的AAA患者在研究期末的死亡率显著高于无癌症病史的患者（21.21%对17.08%，P < 0.0001，HR，1.31，95%CI，1.17 - 1.46）。
AAA患者的癌症病史会增加长期死亡率，但不影响AAA修复术后的短期死亡率。然而，AAA修复可能会增加有肺癌病史患者的短期和长期死亡率，对于这些病例应更谨慎地选择。
