Su Chen, Wang Yan, Wu Fang, Qiu Yumin, Tao Jun
Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Front Cardiovasc Med. 2022 Jun 6;9:857194. doi: 10.3389/fcvm.2022.857194. eCollection 2022.
Previous studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.
Patients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.
Of the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76-2.02) and 1.65-times (95% CI, 1.63-1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both < 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.
This study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.
先前的研究表明，被诊断患有癌症的患者自杀和心血管疾病死亡风险升高。然而，多重原发性癌症（MPC）诊断对自杀和心血管疾病死亡风险的影响仍不明确。本研究旨在确定美国MPC患者的自杀和心血管疾病死亡风险。
在一项回顾性队列研究中，从监测、流行病学和最终结果数据库中选取1975年至2016年间患有单一或MPC的患者。估计MPC患者的自杀和心血管疾病死亡率及标准化死亡率（SMR）。
在本分析纳入的645,818例诊断为MPC的患者中，分别观察到760例自杀死亡和36,209例心血管疾病死亡。自杀和心血管疾病死亡率分别是普通人群的1.89倍（95%CI，1.76 - 2.02）和1.65倍（95%CI，1.63 - 1.67）。MPC患者自杀和心血管疾病的累积死亡率显著高于单一原发性癌症患者（均P < 0.001）。在异步诊断的MPC患者中，自杀和心血管疾病的累积发病率高于同步诊断的患者。在所有MPC中，胰腺癌和食管癌的自杀SMR最高（分别为5.98和5.67），而急性髓系白血病和脑癌的心血管疾病SMR最高（分别为3.87和3.62）。自杀SMR在诊断后1年内最高，而心血管疾病SMR在诊断后5年最高。
本研究表明，MPC患者的自杀和心血管疾病死亡率高于单一原发性癌症患者。因此，我们的结果强调了对MPC患者进行自杀和心血管疾病心理评估及针对性预防干预的必要性。
