Epple Jasmin, Lingwal Neelam, Schmitz-Rixen Thomas, Böckler Dittmar, Grundmann Reinhart T
Department of Vascular and Endovascular Surgery, University Hospital, Goethe- University, Frankfurt am Main, Germany; Department of Biostatistics and Mathematical Modeling, University Hospital, Goethe-University, Frankfurt am Main, Germany; Goethe-University, Frankfurt am Main, Germany; Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany; German Institute for Health Research in Vascular Medicine (DIGG gGmbH), Berlin, Germany.
Dtsch Arztebl Int. 2023 Sep 4;120(35-36):589-594. doi: 10.3238/arztebl.m2023.0157.
Having cancer adversely effects the outcome of treatment for an unruptured abdominal aortic aneurysm (AAA).
A retrospective secondary analysis was performed on the basis of anonymized data from AOK, a German nationwide statutory healthinsurance carrier. Data were evaluated from all of the 20 683 patients who underwent either endovascular (EVAR, 15 792) or open surgical (OAR, 4891) treatment for an unruptured AAA in the years 2010-2016. It was determined in each case whether the patient had a known cancer at the time of the procedure to treat AAA. The analysis concerned patient characteristics, periprocedural complications, and survival after the procedure up to 31 December 2018.
18 222 patients were free of cancer. In accordance with the known 6:1 sex ratio of AAA, 85.3% of the cancer-free patients and 92.8% of those with cancer were men. At the time of their AAA procedure, 1398 had cancer of the intestine (n = 318), lung (n = 301), prostate (n = 380), or bladder or ureter (n = 399). One-year survival after the AAA procedure was 91.5% in cancer-free patients and 84%, 74.4%, 85.8%, and 85.5% in the patients with the respective types of cancer just mentioned. Having cancer was a significant risk factor for periprocedural mortality (OR 1.326, p = 0.041) and for long-term survival (HR 1.515; p < 0.001).
Having cancer is a risk factor for periprocedural mortality and long-term survival in patients undergoing treatment for an unruptured AAA. This implies that the indications for surgery should be considered with care, particularly in patients with lung cancer, whose 5-year survival rate is only 37.2%.
患有癌症会对未破裂腹主动脉瘤（AAA）的治疗结果产生不利影响。
基于德国全国性法定健康保险公司AOK的匿名数据进行回顾性二次分析。对2010年至2016年期间接受未破裂AAA血管内治疗（EVAR，15792例）或开放手术（OAR，4891例）的所有20683例患者的数据进行评估。确定在治疗AAA时每位患者是否患有已知癌症。分析涉及患者特征、围手术期并发症以及截至2018年12月31日手术后的生存率。
18222例患者无癌症。按照已知的AAA 6:1性别比例，无癌症患者中85.3%为男性，有癌症患者中92.8%为男性。在进行AAA手术时，1398例患者患有肠道癌（n = 318）、肺癌（n = 301）、前列腺癌（n = 380）或膀胱或输尿管癌（n = 399）。AAA手术后无癌症患者的1年生存率为91.5%，上述各类型癌症患者的1年生存率分别为84%、74.4%、85.8%和85.5%。患有癌症是围手术期死亡率（OR 1.326，p = 0.041）和长期生存率（HR 1.515；p < 0.001）的重要危险因素。
患有癌症是未破裂AAA患者围手术期死亡率和长期生存率的危险因素。这意味着手术指征应谨慎考虑，尤其是对于5年生存率仅为37.2%的肺癌患者。
