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心力衰竭患者新发癌症:流行病学、病理生理学和临床管理。

New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management.

机构信息

Department of Translational Medical Sciences, Federico II University, Naples, Italy.

Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy.

出版信息

Curr Heart Fail Rep. 2021 Aug;18(4):191-199. doi: 10.1007/s11897-021-00517-y. Epub 2021 Jun 28.

Abstract

PURPOSE OF REVIEW

Oncological treatments are known to induce cardiac toxicity, but the impact of new-onset cancer in patients with pre-existing HF remains unknown. This review focuses on the epidemiology, pathophysiological mechanisms, and clinical implications of HF patients who develop malignancies.

RECENT FINDINGS

Novel findings suggest that HF and cancer, beside common risk factors, are deeply linked by shared pathophysiological mechanisms. In particular, HF itself may enhance carcinogenesis by producing pro-inflammatory cytokines, and it has been suggested that neurohormonal activation, commonly associated with the failing heart, might play a pivotal role in promoting neoplastic transformation. The risk of malignancies seems to be higher in HF patients compared to the general population, probably due to shared risk factors and common pathophysiological pathways. Additionally, management of these patients represents a challenge for clinicians, considering that the co-existence of these diseases significantly worsens patients' prognosis and negatively affects therapeutic options for both diseases.

摘要

目的综述

已知肿瘤治疗会引发心脏毒性,但患有 HF 的患者新发癌症的影响尚不清楚。本综述重点关注患有 HF 但新发恶性肿瘤的患者的流行病学、病理生理机制和临床意义。

最近的发现

新的研究结果表明,HF 和癌症除了有共同的危险因素外,还存在共同的病理生理机制。具体来说,HF 本身可能通过产生促炎细胞因子而促进肿瘤发生,有人提出,与衰竭心脏相关的神经激素激活可能在促进肿瘤转化方面发挥关键作用。与一般人群相比,HF 患者发生恶性肿瘤的风险似乎更高,这可能是由于共同的危险因素和共同的病理生理途径。此外,由于这些疾病的共存显著恶化了患者的预后,并对两种疾病的治疗选择产生负面影响,因此管理这些患者对临床医生来说是一个挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b4e/8342372/d096834a5454/11897_2021_517_Fig1_HTML.jpg

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