Zhu Jie, Chen Yue, Zhang Yuanlong, Wang Wei, Wang Yujue, Lu Zhuo, Zhang Yulin, Lei Haike, Li Dairong, Long Bo, Liu Haixia
Department of Cardio-Oncology, Chongqing University Cancer Hospital, Chongqing, China.
School of Medicine, Chongqing University, Chongqing, China.
Cancer Med. 2023 Sep;12(18):18531-18541. doi: 10.1002/cam4.6455. Epub 2023 Aug 16.
Immune checkpoint inhibitors (ICIs) have emerged as a standard treatment for various malignancies. However, research indicates blocking the immune checkpoint pathway may exacerbate atherosclerotic lesions.
We aimed to investigate whether ICI therapy increases the risk of arterial thromboembolic events (ATEs).
A retrospective cohort study was conducted on patients with histologically confirmed cancer at our institution between 2018 and 2021, using the propensity score matching method. The primary endpoint was ATEs occurrence, comprising acute coronary syndrome, stroke/transient ischemic attack, and peripheral arterial thromboembolism. Subgroup analyses assessed whether the ICI treatment effect on ATEs varied over time by limiting the maximum follow-up duration. Logistic regression analysis identified ATE risk factors in ICI-treated patients.
Overall, the ICI group (n = 2877) demonstrated an ATEs risk 2.01 times higher than the non-ICI group (RR, 2.01 [95% CI (1.61-2.51)]; p < 0.001). Subgroup analysis revealed no significant increase in ATEs risk for ICI-treated patients within 1 year (Limited to a max 9-month follow-up, p = 0.075). However, ATEs risk in the ICI group rose by 41% at 1 year (p = 0.010) and 97% at 4 years (p ≤ 0.001). Age, diabetes, hypertension, peripheral atherosclerosis, atrial fibrillation, chronic ischemic heart disease, distant cancer metastasis, and ICI treatment cycles contributed to ATEs risk elevation in ICI-treated patients.
ICI-treated patients may exhibit a higher risk of ATEs, especially after 1 year of treatment.
免疫检查点抑制剂（ICIs）已成为各种恶性肿瘤的标准治疗方法。然而，研究表明阻断免疫检查点通路可能会加剧动脉粥样硬化病变。
我们旨在研究ICI治疗是否会增加动脉血栓栓塞事件（ATEs）的风险。
采用倾向评分匹配法，对2018年至2021年在我院组织学确诊为癌症的患者进行回顾性队列研究。主要终点是ATEs的发生，包括急性冠状动脉综合征、中风/短暂性脑缺血发作和外周动脉血栓栓塞。亚组分析通过限制最大随访时间来评估ICI治疗对ATEs的影响是否随时间变化。逻辑回归分析确定了接受ICI治疗患者的ATEs危险因素。
总体而言，ICI组（n = 2877）发生ATEs的风险比非ICI组高2.01倍（RR，2.01 [95% CI (1.61 - 2.51)]；p < 0.001）。亚组分析显示，在1年内接受ICI治疗的患者中，ATEs风险没有显著增加（限于最长9个月的随访，p = 0.075）。然而，ICI组在1年时ATEs风险增加了41%（p = 0.010），在4年时增加了97%（p ≤ 0.001）。年龄、糖尿病、高血压、外周动脉粥样硬化、心房颤动、慢性缺血性心脏病、远处癌症转移和ICI治疗周期导致接受ICI治疗患者的ATEs风险升高。
接受ICI治疗的患者可能表现出更高的ATEs风险，尤其是在治疗1年后。
