Unité et consultations de médecine vasculaire, CH Toulon, La Seyne sur mer, France.
Clinique d'Alembert, Grenoble, France.
J Med Vasc. 2022 Jul-Aug;47(3):133-140. doi: 10.1016/j.jdmv.2022.07.003. Epub 2022 Aug 10.
Cancer is the leading cause of death in European countries, ahead of cardiovascular diseases. Cancer is also the most common co-morbidity among patients hospitalized for the management of cardiovascular diseases. Through an overview, we searched for the frequency and types of cancer associated with peripheral arterial disease (PAD) in order to address the relevance of cancer screening in patients with PAD.
We searched in PubMed database from 1996 to 2020 for retrospective and prospective cohort or cross-sectional or randomized studies evaluating the frequency of all types of cancer in patients with PAD excluding patients with aneurysmal disease. The keywords used were: peripheral arterial disease, arterial thrombosis, acute leg ischemia, critical leg ischemia, chronic leg ischemia, intermittent claudication, malignant tumor, cancer.
Based on published studies, the frequency of cancer in patients with PAD varied widely from 3.8 to 30.4% depending on study design, population, method used to screen for cancer and study period. In medical records database and registers,cancer prevalence varied from 3,8% to 22,4% in 4 retrospective studies of patients with acute limb ischemia and from 10.5 to 30.4% in 3 prospective studies of patients with acute limb ischemia, critical ischemia or intermittent claudication. In 3 retrospective analyses from 2 population-based cohorts and health insurance claims data, incidence of cancer in patients with intermittent claudication, acute limb ischemia or peripheral arterial disease varied from 8% to 11.7%. The frequency of cancer in PAD patients appeared higher than in the general population. Tobacco-dependent cancers seemed to be the most common cancers in PAD. Cancers were also more frequent in case of anemia, amputation and iterative bypass thrombosis in few studies.
Although there is no recommendation for cancer screening in patients with PAD, the high prevalence of cancer raises the question of screening patients at high risk such as those with acute or critical limb ischemia and especially in case of severe tobacco use, anemia, amputation and iterative bypass thrombosis. These results call for further studies with larger sample size and long term follow-up.
癌症是欧洲国家的主要死亡原因，超过心血管疾病。癌症也是因心血管疾病住院治疗的患者最常见的合并症之一。通过综述，我们搜索了与外周动脉疾病（PAD）相关的癌症的频率和类型，以探讨在 PAD 患者中进行癌症筛查的相关性。
我们在 PubMed 数据库中搜索了 1996 年至 2020 年期间的回顾性和前瞻性队列或横断面或随机研究，评估了排除动脉瘤疾病患者后 PAD 患者的所有类型癌症的频率。使用的关键词为：外周动脉疾病、动脉血栓形成、急性腿部缺血、严重腿部缺血、慢性腿部缺血、间歇性跛行、恶性肿瘤、癌症。
根据已发表的研究，PAD 患者的癌症频率差异很大，范围为 3.8%至 30.4%，具体取决于研究设计、人群、用于筛查癌症的方法和研究期间。在病历数据库和登记处，4 项急性肢体缺血患者的回顾性研究中癌症的患病率从 3.8%到 22.4%不等，3 项急性肢体缺血、严重缺血或间歇性跛行患者的前瞻性研究中癌症的患病率从 10.5%到 30.4%不等。在来自 2 个人群队列和健康保险索赔数据的 3 项回顾性分析中，间歇性跛行、急性肢体缺血或外周动脉疾病患者的癌症发病率从 8%到 11.7%不等。PAD 患者的癌症频率似乎高于一般人群。依赖烟草的癌症似乎是 PAD 中最常见的癌症。在少数研究中，贫血、截肢和反复旁路血栓形成的情况下，癌症也更为常见。
尽管目前不建议对 PAD 患者进行癌症筛查，但癌症的高患病率提出了对高危患者进行筛查的问题，如急性或严重肢体缺血患者，特别是在严重吸烟、贫血、截肢和反复旁路血栓形成的情况下。这些结果呼吁开展进一步的研究，纳入更大的样本量并进行长期随访。
