Wang Zhipeng, Fan Zeyu, Yang Lei, Liu Lifang, Sheng Chao, Song Fengju, Huang Yubei, Chen Kexin
Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China.
Front Cardiovasc Med. 2023 Jan 25;10:1014400. doi: 10.3389/fcvm.2023.1014400. eCollection 2023.
Previous studies focused more on the short-term risk of cardiovascular (CV) death due to traumatic psychological stress after a cancer diagnosis and the acute cardiotoxicity of anticancer treatments than on the long-term risk of CV death.
Time trends in the proportions of CV death (P), cancer death (P), and other causes in deaths from all causes were used to show preliminary relationships among the three causes of death in 4,806,064 patients with cancer from the Surveillance, Epidemiology, and End Results (SEER) program. Competing mortality risk curves were used to investigate when the cumulative CV mortality rate (CMR) began to outweigh the cumulative cancer mortality rate (CMR) for patients with cancer who survived for more than 10 years. Multivariable competing risk models were further used to investigate the potential factors associated with CV death.
For patients with cancer at all sites, the P increased from 22.8% in the 5th year after diagnosis to 31.0% in the 10th year and 35.7% in the 20th year, while the P decreased from 57.7% in the 5th year after diagnosis to 41.2 and 29.9% in the 10th year and 20th year, respectively. The P outweighed the P (34.6% vs. 34.1%) since the 15th year for patients with cancer at all sites, as early as the 9th year for patients with colorectal cancer (37.5% vs. 33.2%) and as late as the 22nd year for patients with breast cancer (33.5% vs. 30.6%). The CMR outweighed the CMR since the 25th year from diagnosis. Multivariate competing risk models showed that an increased risk of CV death was independently associated with older age at diagnosis [hazard ratio and 95% confidence intervals [HR (95%CI)] of 43.39 (21.33, 88.28) for ≥ 80 vs. ≤ 30 years] and local metastasis [1.07 (1.04, 1.10)] and a decreased risk among women [0.82 (0.76, 0.88)], surgery [0.90 (0.87, 0.94)], and chemotherapy [0.85 (0.81, 0.90)] among patients with cancer who survived for more than 10 years. Further analyses of patients with cancer who survived for more than 20 years and sensitivity analyses by cancer at all sites showed similar results.
CV death gradually outweighs cancer death as survival time increases for most patients with cancer. Both the cardio-oncologist and cardio-oncology care should be involved to reduce CV deaths in long-term cancer survivors.
以往研究更多关注癌症诊断后创伤性心理应激导致心血管（CV）死亡的短期风险以及抗癌治疗的急性心脏毒性，而非CV死亡的长期风险。
利用来自监测、流行病学和最终结果（SEER）项目的4806064例癌症患者全因死亡中CV死亡比例（P）、癌症死亡比例（P）及其他死因比例的时间趋势，来展示这三种死因之间的初步关系。采用竞争死亡风险曲线，研究存活超过10年的癌症患者的累积CV死亡率（CMR）何时开始超过累积癌症死亡率（CMR）。进一步使用多变量竞争风险模型，研究与CV死亡相关的潜在因素。
对于所有部位癌症患者，P从诊断后第5年的22.8%增至第10年的31.0%和第20年的35.7%，而P从诊断后第5年的57.7%分别降至第10年的41.2%和第20年的29.9%。所有部位癌症患者自第15年起，CV死亡比例超过癌症死亡比例（34.6%对34.1%）；结直肠癌患者早在第9年（37.5%对33.2%）；乳腺癌患者则晚至第22年（33.5%对30.6%）。自诊断后第25年起，CMR超过CMR。多变量竞争风险模型显示，诊断时年龄较大[≥80岁与≤30岁相比，风险比及95%置信区间[HR（95%CI）]为43.39（21.33，88.28）]、存在局部转移[1.07（1.04，1.10）]以及存活超过10年的癌症患者中女性[0.82（0.76，0.88）]、接受手术[0.90（0.87，0.94）]和化疗[0.85（0.81，0.90）]者风险降低与CV死亡风险增加独立相关。对存活超过20年的癌症患者的进一步分析以及所有部位癌症的敏感性分析显示了相似结果。
对于大多数癌症患者，随着生存时间增加，CV死亡逐渐超过癌症死亡。心脏肿瘤学家和心脏肿瘤护理均应参与，以降低长期癌症幸存者的CV死亡。
