Medical Department for Haematology and Oncology, Klinikum rechts der Isar Technical University Munich, Munich, Germany.
Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Eur J Vasc Endovasc Surg. 2022 Aug-Sep;64(2-3):255-264. doi: 10.1016/j.ejvs.2022.07.007. Epub 2022 Jul 16.
The purpose of this study was to assess the associations between malignancy, therapeutic regimens, and aorto-iliac aneurysm (i.e., abdominal aortic aneurysm [AAA]) growth rates.
A retrospective single centre analysis identified patients with an AAA plus cancer. Patients who had two or more computed tomography angiograms over six months or more and additional malignancy were included. Clinical data and aneurysm diameters were analysed. AAA growth under cancer therapy (chemotherapy or radiation) was compared with a non-cancer AAA control cohort and to meta-analysis data. Statistics included t tests and a linear regression model with correction for initial aortic diameter and type of treatment.
From 2003 to 2020, 217 patients (median age 70 years; 92% male) with 246 aneurysms (58.8% AAA) and 238 malignancies were identified. Prostate (26.7%) and lung (15.7%) cancer were most frequently seen. One hundred and fifty-seven patients (72.3%) received chemotherapy, 105 patients (48.4%) radiation, and 79 (36.4%) both. Annual AAA growth (mean ± standard deviation) was not statistically significantly different for cancer and non-cancer patients (2.0 ± 2.3 vs. 2.8 ± 2.1 mm/year; p = .20). However, subgroup analyses revealed that radiation was associated with a statistically significantly reduced mean aneurysm growth rate compared with cancer patients without radiation (1.1 ± 1.3 vs. 1.6 ± 2.1 mm/year; p = .046) and to the non-cancer control cohort (1.7 ± 1.9 vs. 2.8 ± 2.1 mm/year; p = .007). Administration of antimetabolites resulted in statistically significantly increased AAA growth (+ 0.9 mm/year; p = .011), while topoisomerase inhibitors (- 0.8 mm/year; p = .17) and anti-androgens (- 0.5 mm/year; p = .27) showed a possible trend for reduced growth. Similar observations were noted for iliac aneurysms (n = 85). Additionally, the effects persisted for chemotherapy combinations (2.6 ± 1.4 substances/patient).
Patients with cancer and concomitant aortic aneurysms may require intensified monitoring when undergoing specific therapies, such as antimetabolite treatment, as they may experience an increased aneurysm growth rate. Radiation may be associated with reduced aneurysm growth.
本研究旨在评估恶性肿瘤、治疗方案与腹主动脉瘤（即，主动脉瘤）生长速度之间的相关性。
回顾性单中心分析纳入了患有主动脉瘤合并癌症的患者。纳入标准为在六个月或更长时间内进行了两次或更多次计算机断层血管造影检查，并且有其他恶性肿瘤的患者。分析了临床数据和动脉瘤直径。将癌症治疗（化疗或放疗）下的主动脉瘤生长速度与非癌症主动脉瘤对照组和荟萃分析数据进行比较。统计学分析包括 t 检验和线性回归模型，校正初始主动脉直径和治疗类型。
2003 年至 2020 年期间，共纳入 217 例（中位年龄 70 岁，92%为男性）患者，共 246 个动脉瘤（58.8%为主动脉瘤）和 238 例恶性肿瘤。最常见的恶性肿瘤为前列腺癌（26.7%）和肺癌（15.7%）。157 例（72.3%）患者接受了化疗，105 例（48.4%）患者接受了放疗，79 例（36.4%）患者同时接受了两种治疗。癌症患者和非癌症患者的主动脉瘤年生长速度（平均值±标准差）无统计学差异（分别为 2.0±2.3 毫米/年和 2.8±2.1 毫米/年；p=0.20）。然而，亚组分析显示，与未接受放疗的癌症患者（1.1±1.3 毫米/年）和非癌症对照组（1.7±1.9 毫米/年）相比，放疗与统计学显著降低的平均动脉瘤生长速度相关（p=0.046）。使用代谢抑制剂治疗与统计学显著增加的主动脉瘤生长速度相关（+0.9 毫米/年；p=0.011），而拓扑异构酶抑制剂（-0.8 毫米/年；p=0.17）和抗雄激素药物（-0.5 毫米/年；p=0.27）则可能与生长速度减缓有关。对髂动脉瘤（n=85）也有类似的观察结果。此外，在使用多种化疗药物（2.6±1.4 种/患者）时，这些影响仍然存在。
接受特定治疗（如代谢抑制剂治疗）的癌症合并主动脉瘤患者，其动脉瘤生长速度可能会增加，因此可能需要更密切的监测。放疗可能与动脉瘤生长速度减缓有关。
