Wang Lidong, Wang Ting, Zhang Wu, Zheng Shusen
The Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang, PR China.
Heliyon. 2024 Sep 11;10(19):e37869. doi: 10.1016/j.heliyon.2024.e37869. eCollection 2024 Oct 15.
The prognosis of primary liver cancer (PLC) was influenced by death due to non-cancer causes, particularly death related to cardiovascular disease (CVD). This study aimed to analyze mortality of non-cancer causes and identify the independent risk factors associated with CVD-related deaths in PLC patients.
In total, 112140 patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). Independent risk factors for death from CVD in patients with PLC were identified by Cox proportional hazards model.
The median follow-up time of all PLC patients was 76 months (interquartile range (IQR): 36-129). The median overall survival (OS) was 12 months (IQR: 3-40). Patients with intrahepatic cholangiocarcinoma (ICC) had shorter OS than patients with hepatocellular carcinoma (HCC) (8 vs. 14 months; < 0.001). A total of 87299 deaths were observed, among which 61477 (70.42 % of all deaths) were from PLC, and 12727 (14.58 % of all deaths) were from other cancers. Of all non-cancer deaths (9276, 10.63 %), 2860(30.86 %) were results of CVD. PLC patients had higher risks on CVD-related deaths, compared with general population (standard mortality ratio, SMR, 2.20; 95 % confidence interval, CI, 2.12-2.28). Typically, the highest SMRs appeared in the first year following cancer diagnosis. The multivariable analysis revealed the characteristics listed as followed to be independently risk factors of CVD: age, male (hazard ratio, HR: 1.248, 95%CI: 1.147-1.359), black race (HR: 1.334, 95%CI: 1.195-1.490), year 2016-2019 of diagnosis (HR 0.758, 95%CI: 0.671-0.856), ICC (HR: 1.202, 95%CI: 1.086-1.330), without surgery (HR: 2.479, 95%CI: 2.266-2.711) and without chemotherapy (HR: 2.211, 95%CI: 2.033-2.403).
It is essential to take cardiovascular health into consideration at the time of diagnosis for PLC patients as the risk of CVD mortality is significantly higher than that of general population.
原发性肝癌（PLC）的预后受到非癌症原因导致的死亡影响，尤其是与心血管疾病（CVD）相关的死亡。本研究旨在分析非癌症原因的死亡率，并确定PLC患者中与CVD相关死亡的独立危险因素。
总共从监测、流行病学和最终结果（SEER）数据库（2000 - 2019年）纳入了112140例患者。通过Cox比例风险模型确定PLC患者中CVD死亡的独立危险因素。
所有PLC患者的中位随访时间为76个月（四分位间距（IQR）：36 - 129）。中位总生存期（OS）为12个月（IQR：3 - 40）。肝内胆管癌（ICC）患者的OS短于肝细胞癌（HCC）患者（8个月对14个月；<0.001）。共观察到87299例死亡，其中61477例（占所有死亡的70.42%）死于PLC，12727例（占所有死亡的14.58%）死于其他癌症。在所有非癌症死亡（9276例，占10.63%）中，2860例（占30.86%）是CVD的结果。与一般人群相比，PLC患者发生CVD相关死亡的风险更高（标准化死亡比，SMR，2.20；95%置信区间，CI，2.12 - 2.28）。通常，最高的SMR出现在癌症诊断后的第一年。多变量分析显示，以下特征是CVD的独立危险因素：年龄、男性（风险比，HR：1.248，95%CI：1.147 - 1.359）、黑人种族（HR：1.334，95%CI：1.195 - 1.490）、2016 - 2019年诊断（HR 0.758，95%CI：0.671 - 0.856）、ICC（HR：1.202，95%CI：1.086 - 1.330）、未进行手术（HR：2.479，95%CI：2.266 - 2.711）和未进行化疗（HR：2.211，95%CI：2.033 - 2.403）。
对于PLC患者，在诊断时必须考虑心血管健康，因为CVD死亡风险显著高于一般人群。
