Guan Tianwang, Monteiro Olivia, Chen Dongting, Luo Zehao, Chi Kaiyi, Li Zhihao, Liang Yinglan, Lu Zhenxing, Jiang Yanting, Yang Jinming, Lin Wenrui, Yi Min, Zhang Kang, Ou Caiwen
Cancer Center, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China.
Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China.
J Adv Res. 2025 Mar;69:215-224. doi: 10.1016/j.jare.2024.03.017. Epub 2024 Mar 26.
Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers.
To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites.
A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs).
In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]-19·85[95 %CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]-19·25[95 %CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]-24·71[95 %CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group.
The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.
先前关于癌症患者心血管疾病（CVD）死亡风险的研究主要集中在总体癌症、年龄亚组和单一癌症上。
评估21个癌症部位的非转移性癌症患者的CVD死亡风险。
本基于人群的研究纳入了监测、流行病学和最终结果（SEER）数据库（1975 - 2018年）中的1,672,561例非转移性癌症患者，中位随访时间为12.7年。使用比例、竞争风险回归、绝对超额风险（AER）和标准化死亡率（SMR）评估CVD死亡风险。
在局限性癌症患者中，高竞争风险组（21种独特癌症中的14种）的CVD死亡比例和CVD累积死亡率在癌症诊断后超过了原发性肿瘤。发现非转移性癌症患者的CVD的SMR和AER高于美国普通人群（SMR 1.96 [95%CI，1.95 - 1.97] - 19.85 [95%CI，16.69 - 23.44]；AER 5.77 - 210.48）、心脏病（SMR 1.94 [95%CI，1.93 - 1.95] - 19.25 [95%CI，15.76 - 23.29]；AER 4.36 - 159.10）和脑血管疾病（SMR 2.05 [95%CI，2.02 - 2.08] - 24.71 [95%CI，16.28 - 35.96]；AER 1.01 - 37.44）死亡。在高竞争风险组中，局限性癌症患者的CVD相关SMR随生存时间增加，但在低竞争风险组（21种癌症中的7种）中呈反勺型模式。高竞争风险组的CVD相关死亡风险高于低竞争风险组。
非转移性癌症患者的CVD死亡风险因癌症分期、部位和生存时间而异。21种局限性癌症中有14种（高竞争癌症）的CVD死亡风险较高。需要针对非转移性癌症患者的CVD管理制定有针对性的策略。
