Mennander Ari, Nielsen Susanne J, Skyttä Tanja, Smith Maya Landenhed, Martinsson Andreas, Pivodic Aldina, Hansson Emma C, Jeppsson Anders
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Tampere University Hospital, Heart Hospital, Tampere, Finland.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Thorac Cardiovasc Surg. 2024 Aug 15. doi: 10.1016/j.jtcvs.2024.08.006.
Previous studies indicate an increased long-term risk for incident cancer and cancer-specific mortality in patients undergoing cardiac surgery. We compared the risk for incident cancer and cancer-specific mortality between patients and matched control subjects from the general population.
All patients (n = 127,119) undergoing first-time coronary artery or heart valve surgery in Sweden during 1997-2020 were included in a population-based observational cohort study based on individual data from the SWEDEHEART registry and 4 other mandatory national registries. The patients were compared with an age-, sex-, and place of residence-matched control population (n = 415,287) using multivariable Cox proportional hazards regression models adjusted for baseline characteristics, comorbidities, and socioeconomic factors. A propensity score-matched analysis with 81,522 well-balanced pairs was also performed.
Median follow-up was 9.2 (range, 0-24) years. A total of 31,361/127,119 patients (24.7%) and 102,959/415,287 control subjects (24.8%) developed cancer during follow-up. The crude event rates were 2.75 and 2.83 per 100 person-years, respectively. The adjusted risk for cancer and cancer-specific mortality was lower in patients (adjusted hazard ratios 0.86 [95% CI, 0.85-0.88] and 0.64 [95% CI, 0.62-0.65], respectively). The propensity score-matched analysis showed similar results (hazard ratios, 0.88 [95% CI, 0.86-0.90] and 0.65 [95% CI, 0.63-0.68], respectively). The results were consistent in subgroups based on sex, age, and comorbidities.
Patients who underwent cardiac surgery have lower risk for cancer and cancer-specific mortality than matched control subjects.
既往研究表明，接受心脏手术的患者发生癌症及癌症特异性死亡的长期风险增加。我们比较了心脏手术患者与来自普通人群的匹配对照者发生癌症及癌症特异性死亡的风险。
纳入1997年至2020年期间在瑞典接受首次冠状动脉或心脏瓣膜手术的所有患者（n = 127,119），进行一项基于人群的观察性队列研究，数据来源于瑞典心脏注册研究（SWEDEHEART）及其他4个国家强制注册研究的个体数据。使用多变量Cox比例风险回归模型，根据基线特征、合并症和社会经济因素进行调整，将患者与年龄、性别和居住地点匹配的对照人群（n = 415,287）进行比较。还进行了倾向评分匹配分析，共81,522对匹配良好的配对。
中位随访时间为9.2（范围0 - 24）年。随访期间，共有31,361/127,119例患者（24.7%）和102,959/415,287例对照者（24.8%）发生癌症。粗事件发生率分别为每100人年2.75例和2.83例。患者发生癌症及癌症特异性死亡的校正风险较低（校正风险比分别为0.86 [95% CI，0.85 - 0.88]和0.64 [95% CI，0.62 - 0.65]）。倾向评分匹配分析显示了相似的结果（风险比分别为0.88 [95% CI, 0.86 - 0.90]和0.65 [95% CI, 0.63 - 0.68]）。基于性别、年龄和合并症的亚组分析结果一致。
接受心脏手术的患者发生癌症及癌症特异性死亡的风险低于匹配的对照者。
