Nakamura Junichi, Tsujino Ichizo, Masaki Kohei, Hosokawa Kazuya, Funakoshi Kouta, Taniguchi Yu, Adachi Shiro, Inami Takumi, Yamashita Jun, Ogino Hitoshi, Hatano Masaru, Yaoita Nobuhiro, Ikeda Nobutaka, Shimokawahara Hiroto, Tanabe Nobuhiro, Kubota Kayoko, Shigeta Ayako, Ogihara Yoshito, Horimoto Koshin, Dohi Yoshihiro, Kawakami Takashi, Tamura Yuichi, Tatsumi Koichiro, Abe Kohtaro
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
J Heart Lung Transplant. 2025 Mar;44(3):339-348. doi: 10.1016/j.healun.2024.10.022. Epub 2024 Oct 30.
The management of chronic thromboembolic pulmonary hypertension (CTEPH) has advanced significantly in recent years, thereby improving patient prognosis. However, the impact of cancer on the outcomes of patients with CTEPH under current treatment remains unclear. This study aimed to investigate the prevalence of cancer in patients with CTEPH and determine how comorbid cancer affects their prognosis and clinical course.
Data from an ongoing Japanese prospective cohort study were analyzed. Prevalence and primary cancer sites were evaluated. The association of a history of cancer with a composite endpoint, including all-cause death, lung transplantation, and worsening of CTEPH, as well as venous thromboembolism and bleeding events, was assessed.
Of the 1,270 patients in the cohort, 134 (10.6%) had a history of cancer, with the most common primary sites being the breast in women and the prostate in men. The incidence of composite outcome and all-cause death was higher in those with a history of cancer (p < 0.001, log-rank test). In the Cox proportional hazard model, age- and sex-adjusted hazard ratios for the composite outcome and all-cause death were 2.69 (95% confidence interval, 1.48-4.89, p = 0.001) and 4.25 (95% confidence interval, 1.98-9.10, p < 0.001), respectively, for patients with a history of cancer. No significant differences in venous thromboembolism and bleeding events were observed between patients with and those without a history of cancer.
A history of cancer, with a prevalence of 10.6%, is an independent risk factor for mortality in patients with CTEPH undergoing the currently recommended treatment.
近年来，慢性血栓栓塞性肺动脉高压（CTEPH）的管理取得了显著进展，从而改善了患者的预后。然而，在当前治疗下，癌症对CTEPH患者预后的影响仍不明确。本研究旨在调查CTEPH患者中癌症的患病率，并确定合并癌症如何影响其预后和临床病程。
分析了一项正在进行的日本前瞻性队列研究的数据。评估了患病率和原发癌部位。评估了癌症病史与复合终点（包括全因死亡、肺移植和CTEPH恶化）以及静脉血栓栓塞和出血事件之间的关联。
该队列中的1270例患者中，134例（10.6%）有癌症病史，女性最常见的原发部位是乳腺，男性是前列腺。有癌症病史的患者复合结局和全因死亡的发生率更高（p<0.001，对数秩检验）。在Cox比例风险模型中，有癌症病史的患者复合结局和全因死亡的年龄和性别调整风险比分别为2.69（95%置信区间，1.48-4.89，p=0.001）和4.25（95%置信区间，1.98-9.10，p<0.001）。有癌症病史和无癌症病史的患者在静脉血栓栓塞和出血事件方面未观察到显著差异。
癌症病史的患病率为10.6%，是接受当前推荐治疗的CTEPH患者死亡的独立危险因素。
