Sørensen Henrik Toft, Skajaa Nils, Klok Frederikus Albertus, Laugesen Kristina, Farkas Dóra Körmendiné
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, DK-8200, Denmark.
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Clin Epidemiol. 2022 Feb 16;14:173-177. doi: 10.2147/CLEP.S345054. eCollection 2022.
Strong evidence indicates that venous thromboembolism is a presenting symptom of cancer. Cancer is a known cause of pulmonary hypertension; however, it remains unknown whether pulmonary hypertension is a marker of occult cancer. We examined the association between a pulmonary hypertension diagnosis and cancer risk in a cohort study using population-based data from the Danish health system.
Using Danish nationwide registries, we identified 6335 patients with a pulmonary hypertension diagnosis and without a previous cancer diagnosis between 1995 and 2017. We computed the age-, sex-, and calendar year-standardized incidence ratio (SIR) as the ratio of observed to expected number of cancers using national incidence rates as the reference. We performed a subgroup analysis among patients with chronic thromboembolic pulmonary hypertension in the period in which a specific code was available (2006-2017).
We identified 212 cancers within the first year of follow-up and 796 cancers thereafter. The one-year risk of cancer was 3.3% and the one-year SIR was 1.96 (95% confidence interval [CI]: 1.70-2.23). In the second and subsequent years, the SIR remained elevated (SIR: 1.15 [95% CI: 1.08-1.24]). In patients with chronic thromboembolic pulmonary hypertension, the one-year SIR was 1.41 (95% CI: 0.82-2.25).
Cancer risk was clearly higher in patients with pulmonary hypertension compared with the general population. The association was particularly strong in the first year of follow-up, but remained elevated thereafter. However, absolute risks were low, limiting the clinical relevance of pursuing early cancer detection in these patients.
有力证据表明静脉血栓栓塞是癌症的一种表现症状。癌症是已知的肺动脉高压病因；然而，肺动脉高压是否为隐匿性癌症的一个标志物仍不清楚。我们在一项队列研究中利用丹麦卫生系统基于人群的数据，研究了肺动脉高压诊断与癌症风险之间的关联。
利用丹麦全国登记处的数据，我们确定了1995年至2017年间6335例诊断为肺动脉高压且既往无癌症诊断的患者。我们计算年龄、性别和日历年标准化发病率（SIR），即将观察到的癌症病例数与使用国家发病率作为参考计算出的预期癌症病例数之比。我们对有慢性血栓栓塞性肺动脉高压的患者在有特定编码的时期（2006 - 2017年）进行了亚组分析。
我们在随访的第一年发现了212例癌症，之后又发现了796例癌症。癌症的一年风险为3.3%，一年SIR为1.96（95%置信区间[CI]：1.70 - 2.23）。在第二年及后续年份，SIR仍保持升高（SIR：1.15[95%CI：1.08 - 1.24]）。在慢性血栓栓塞性肺动脉高压患者中，一年SIR为1.41（95%CI：0.82 - 2.25）。
与普通人群相比，肺动脉高压患者的癌症风险明显更高。这种关联在随访的第一年尤为强烈，但此后仍保持升高。然而，绝对风险较低，限制了对这些患者进行早期癌症检测的临床意义。
