Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany.
Internal Medicine I, Central Hospital Bremerhaven, Bremerhaven, Germany.
ESC Heart Fail. 2021 Oct;8(5):3628-3633. doi: 10.1002/ehf2.13421. Epub 2021 Jun 27.
The prognosis and quality of life of heart failure patients is determined to a significant extent by co-morbidities. New data suggest that heart failure may be associated with an increased incidence of cancer. The present retrospective study investigates this association in a large collective of outpatients with heart failure.
This retrospective cohort study assessed the incidence of cancer in patients with an initial diagnosis of heart failure and a matched non-heart failure cohort in 1274 general practices in Germany between January 2000 and December 2018. The study is based on the Disease Analyser database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Hazard regression models were used to study the association between heart failure and the incidences of different cancers. A total of 100 124 patients with heart failure and 100 124 patients without heart failure were included in the analysis. Patients were matched individually by sex, age, diabetes, obesity, and yearly consultation frequency. Within the 10 year observation period, 25.7% of patients with heart failure and 16.2% of patients without heart failure had been diagnosed with cancer (log-rank P < 0.001). These proportions were 28.6% vs. 18.8% in female and 23.2% vs. 13.8% in male patients. Heart failure was significantly associated with the incidence of cancer [hazard ratio (HR), 95% confidence interval: 1.76, 1.71-1.81; P < 0.001 in total; HR: 1.85, 1.77-1.92, P < 0.001 in women; HR: 1.69, 1.63-1.76, P < 0.001 in men]. A significant association was found between heart failure and all cancer sites assessed. The strongest association was observed for cancer of lip, oral cavity, and pharynx (HR: 2.10, 95% confidence interval: 1.66-2.17; P < 0.001), followed by respiratory organs (HR: 1.91, 1.74-2.10; P < 0.001) and genital organs of female patients (HR: 1.86, 1.56-2.17; P < 0.001). The association for skin tumours was 1.83 (1.72-1.94; P < 0.001), for cancer of lymphoid and haematopoietic tissue 1.77 (1.63-1.91; P < 0.001), for cancer of the digestive tract 1.75 (1.64-1. 87; P < 0.001), for breast cancer 1.67 (1.52-1.84; P < 0.001), for cancer of the genitourinary tract 1.64 (1.48-1.81; P < 0.001), and for male genital organ cancer 1.52 (1.40-1.66; P < 0.001).
Our study indicates that heart failure patients experience a significantly higher incidence of cancer during the course of the disease.
心力衰竭患者的预后和生活质量在很大程度上取决于合并症。新数据表明，心力衰竭可能与癌症发病率增加有关。本回顾性研究调查了心力衰竭患者的大样本中这种关联。
本回顾性队列研究评估了 2000 年 1 月至 2018 年 12 月期间德国 1274 家普通诊所中初始诊断为心力衰竭的患者和匹配的非心力衰竭患者的癌症发病率。该研究基于疾病分析器数据库（IQVIA），其中包含药物处方、诊断以及基本医疗和人口统计学数据。使用风险回归模型研究心力衰竭与不同癌症发病率之间的关联。共纳入 100124 例心力衰竭患者和 100124 例无心力衰竭患者进行分析。患者按性别、年龄、糖尿病、肥胖和每年就诊频率进行个体匹配。在 10 年观察期内，心力衰竭患者中有 25.7%和无心力衰竭患者中有 16.2%被诊断患有癌症（对数秩 P<0.001）。女性患者中这一比例分别为 28.6%和 18.8%，男性患者中分别为 23.2%和 13.8%。心力衰竭与癌症的发病率显著相关[风险比（HR），95%置信区间：1.76，1.71-1.81；P<0.001 ；女性 HR：1.85，1.77-1.92，P<0.001；男性 HR：1.69，1.63-1.76，P<0.001]。研究发现心力衰竭与评估的所有癌症部位之间存在显著关联。最强的关联见于唇、口腔和咽癌（HR：2.10，95%置信区间：1.66-2.17；P<0.001），其次是呼吸器官癌（HR：1.91，1.74-2.10；P<0.001）和女性生殖器官癌（HR：1.86，1.56-2.17；P<0.001）。皮肤肿瘤的关联为 1.83（1.72-1.94；P<0.001），淋巴和造血组织癌为 1.77（1.63-1.91；P<0.001），消化道癌为 1.75（1.64-1.87；P<0.001），乳腺癌为 1.67（1.52-1.84；P<0.001），泌尿生殖系统癌为 1.64（1.48-1.81；P<0.001），男性生殖器官癌为 1.52（1.40-1.66；P<0.001）。
本研究表明，心力衰竭患者在疾病过程中经历癌症发病率显著增加。
