National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
The Second Affiliated Hospital of Harbin Medical University Harbin China.
J Am Heart Assoc. 2022 Mar 15;11(6):e023802. doi: 10.1161/JAHA.121.023802. Epub 2022 Mar 5.
Background This study aimed to investigate the association between radiotherapy for cancer and cardiovascular disease (CVD) deaths and evaluate the relative risk for CVD deaths in the general population and among patients with cancer treated with radiotherapy. Methods and Results The statistics of cancers from 16 sites were extracted from the Surveillance, Epidemiology, and End Results database and evaluated. Multivariable Cox proportional hazards regression analysis was used to analyze the association between radiotherapy and cardiovascular-specific survival. The standardized mortality ratio for CVD deaths was estimated by comparing the observed deaths of patients with cancer treated with radiotherapy to the expected deaths of the general population. Of the 2 214 944 patients identified from the database, 292 102 (13.19%) died from CVD. Multivariable Cox proportional hazards regression analyses demonstrated that radiotherapy was an independent risk factor for cardiovascular-specific survival among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. The long-term cardiovascular-specific survival of patients with cancer who underwent radiotherapy was significantly lower than that of patients who did not undergo radiotherapy. The incidence of CVD deaths among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers who underwent radiotherapy was higher than that among the general population. Standardized mortality ratio significantly decreased with increasing age at cancer diagnosis, gradually decreased within 10 years of diagnosis and increased after 10 years of diagnosis. Conclusions Radiotherapy is associated with worse cardiovascular-specific survival in patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. Long-term surveillance of cardiovascular conditions should be performed after radiotherapy.
背景 本研究旨在探讨癌症放疗与心血管疾病（CVD）死亡之间的关联，并评估普通人群和接受放疗的癌症患者发生 CVD 死亡的相对风险。
方法和结果 从监测、流行病学和最终结果数据库中提取了 16 个部位癌症的统计数据并进行了评估。采用多变量 Cox 比例风险回归分析来分析放疗与心血管特异性生存之间的关联。通过比较接受放疗的癌症患者的实际死亡人数与普通人群的预期死亡人数，估计 CVD 死亡的标准化死亡率。从数据库中确定了 2 214 944 名患者，其中 292 102 名（13.19%）死于 CVD。多变量 Cox 比例风险回归分析表明，放疗是肺癌、宫颈癌、子宫体癌和膀胱癌患者心血管特异性生存的独立危险因素。接受放疗的癌症患者的长期心血管特异性生存明显低于未接受放疗的患者。接受放疗的肺癌、宫颈癌、子宫体癌和膀胱癌患者的 CVD 死亡发生率高于普通人群。标准化死亡率随着癌症诊断时年龄的增加而显著降低，在诊断后 10 年内逐渐降低，在诊断后 10 年以上增加。
结论 放疗与肺癌、宫颈癌、子宫体癌和膀胱癌患者的心血管特异性生存较差相关。放疗后应长期监测心血管状况。
