成人癌症幸存者的中风发病率是否增加？系统评价和荟萃分析。
Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis.
机构信息
Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Bearsden, Glasgow, G61 1BD, UK.
出版信息
J Cancer Surviv. 2022 Dec;16(6):1414-1448. doi: 10.1007/s11764-021-01122-7. Epub 2021 Nov 5.
PURPOSE
Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer.
METHODS
Medline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-effects meta-analyses and quality assessment were performed.
RESULTS
Thirty-six studies were narratively synthesised. Meta-analysis was conducted using seven studies. Methodological quality was high for most studies. Study populations were heterogeneous, and the length of follow-up and risk factors varied. There was a variation in risk between different cancer types and according to stroke type: pancreatic (HR 2.85 (95% CI 2.43-3.36), ischaemic) (HR 2.28 (95% CI 1.43-3.63), haemorrhagic); lung (HR 2.33 (95% CI 1.63-3.35), ischaemic) (HR 2.14 (95% CI 1.45-3.15), haemorrhagic); and head and neck (HR 1.54 (95% CI 1.40-1.69), haemorrhagic) cancers were associated with significantly increased incidence of stroke. Risk is highest within the first 6 months of diagnosis. Narrative synthesis indicated that several studies also showed significantly increased incidence of stroke in individuals with colorectal cancer, breast cancer, ovarian cancer, nasopharyngeal cancer, leukaemia, and myeloma, and those who have received radiotherapy for head and neck cancers and platinum-based chemotherapy may also have higher stroke incidence.
CONCLUSIONS
Stroke incidence is significantly increased after diagnosis of certain cancers.
IMPLICATIONS FOR CANCER SURVIVORS
Cardiovascular risk should be assessed during cancer survivorship care, with attention to modifying shared cancer/cardiovascular risk factors.
目的
现有研究表明，癌症患者及其康复者发生中风的风险增加。然而，目前尚缺乏足够的证据为癌症患者的具体中风预防或管理提供适当的指导。本研究进行了系统评价和荟萃分析，以描述和量化癌症患者及其康复者的中风发病率。
方法
通过检索 Medline、CINAHL 和 EMBASE 数据库，收集比较癌症患者和非癌症患者中风发病率的流行病学研究。 reviewers 独立提取数据；采用随机效应荟萃分析和质量评估。
结果
36 项研究进行了叙述性综合分析。Meta 分析纳入了 7 项研究。大多数研究的方法学质量较高。研究人群存在异质性，随访时间和危险因素各不相同。不同癌症类型和中风类型之间的风险存在差异：胰腺癌（HR 2.85（95% CI 2.43-3.36），缺血性）（HR 2.28（95% CI 1.43-3.63），出血性）；肺癌（HR 2.33（95% CI 1.63-3.35），缺血性）（HR 2.14（95% CI 1.45-3.15），出血性）；头颈部癌症（HR 1.54（95% CI 1.40-1.69），出血性）与中风发病率显著升高相关。风险在诊断后 6 个月内最高。叙述性综合分析表明，几项研究还表明，结直肠癌、乳腺癌、卵巢癌、鼻咽癌、白血病和骨髓瘤患者以及接受头颈部癌症放疗和铂类化疗的患者中风发病率显著增加。
结论
某些癌症确诊后中风发病率显著增加。
对癌症幸存者的启示
癌症康复期应评估心血管风险，并注意调整共同的癌症/心血管风险因素。
Zotero 插件