Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
J Cardiol. 2021 Mar;77(3):231-238. doi: 10.1016/j.jjcc.2020.07.026. Epub 2020 Aug 28.
Heart failure (HF) and cancer are currently two leading causes of mortality, and sometimes coexist. However, the relationship between them is not completely elucidated. We aimed to investigate whether patients with HF are predisposed to cancer development using the large Korean National Health Insurance claims database.
This study included 128,441 HF patients without a history of cancer and 642,205 age- and sex-matched individuals with no history of cancer and HF between 1 January 2010 and 31 December 2015.
During a median follow-up of 4.06 years, 11,808 patients from the HF group and 40,805 participants from the control were newly diagnosed with cancer (cumulative incidence, 9.2% vs. 6.4%, p < 0.0001). Patients with HF presented a higher risk for cancer development compared to controls in multivariable Cox analysis [hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.61-1.68]. The increased risk was consistent for all site-specific cancers. To minimize potential surveillance bias, additional analysis was performed by eliminating participants who developed cancer within the initial 2 years of HF diagnosis (i.e. 2-year lag analysis). In the 2-year lag analysis, the higher risk of overall cancer remained significant in patients with HF (HR 1.09, 95% CI 1.05-1.13), although the association was weaker. Among the site-specific cancers, three types of cancer (lung, liver/biliary/pancreas, and hematologic malignancy) were consistently at higher risk in patients with HF. An exploratory analysis showed that patients with repeated HF hospitalization had a higher risk of cancer development compared to those without, in a pattern of stepwise increases across the three groups [controls vs. HF without re-hospitalization vs. HF with re-hospitalization ≥1; HR (95% CI), 1.00 (reference) vs. 1.55 (1.51-1.59) vs. 1.96 (1.89-2.03), respectively].
Cancer incidence is higher in patients with HF than the general population. Active surveillance of coexisting malignancy needs to be considered in these patients.
心力衰竭（HF）和癌症是目前导致死亡的两个主要原因，有时同时存在。然而，它们之间的关系尚未完全阐明。我们旨在使用大型韩国国家健康保险索赔数据库研究心力衰竭患者是否易患癌症发展。
本研究纳入了 128441 名无癌症病史的心力衰竭患者和 642205 名年龄和性别匹配的无癌症和心力衰竭病史的个体，他们的随访时间为 2010 年 1 月 1 日至 2015 年 12 月 31 日。
在中位随访 4.06 年期间，HF 组中有 11808 名患者和对照组中有 40805 名参与者新诊断为癌症（累积发病率分别为 9.2%和 6.4%，p<0.0001）。多变量 Cox 分析显示，与对照组相比，HF 患者发生癌症的风险更高[风险比（HR）1.64，95%置信区间（CI）1.61-1.68]。所有部位特异性癌症的风险均增加。为了最大限度地减少潜在的监测偏倚，通过消除心力衰竭诊断后 2 年内发生癌症的参与者（即 2 年滞后分析）进行了额外分析。在 2 年滞后分析中，HF 患者的整体癌症风险仍然显著升高（HR 1.09，95%CI 1.05-1.13），尽管关联较弱。在部位特异性癌症中，三种癌症（肺癌、肝/胆/胰腺和血液恶性肿瘤）在 HF 患者中的风险始终较高。一项探索性分析显示，与无重复心力衰竭住院的患者相比，重复心力衰竭住院的患者发生癌症的风险更高，且在三组患者中呈逐步递增模式[对照组 vs. 无重复心力衰竭住院患者 vs. 重复心力衰竭住院≥1 次的患者；HR（95%CI），1.00（参考）vs. 1.55（1.51-1.59）vs. 1.96（1.89-2.03）]。
HF 患者的癌症发病率高于一般人群。需要考虑对这些患者进行共存恶性肿瘤的主动监测。
