Fujii Hiroyuki, Taniguchi Yu, Tamura Yuichi, Sakamoto Miki, Yoneda Sachiyo, Yanaka Kenichi, Emoto Noriaki, Hirata Ken-Ichi, Otake Hiromasa
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan.
Pulmonary Hypertension Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
BMC Pulm Med. 2025 Jan 2;25(1):2. doi: 10.1186/s12890-024-03460-5.
Prognosis of chronic thromboembolic pulmonary hypertension (CTEPH) has improved after the availability of balloon pulmonary angioplasty (BPA) and approved drugs. However, the clinical effects of cancer, which is one of the associated medical conditions of CTEPH, remain unclear. We aimed to investigate prognosis in patients with CTEPH and comorbid cancer.
Between January 2011 and December 2022, data of 264 consecutive patients with CTEPH who were treated with pulmonary endarterectomy, BPA, or medical therapy were retrospectively analyzed. The patients were allocated, based on the comorbidity of cancer as of December 2022, into the cancer (n = 47) and non-cancer (n = 217) groups. In the cancer group, active and non-active cancers were identified in 30 (64%) and 17 (36%) patients, respectively.
The baseline characteristics, hemodynamics, and treatments were similar between the groups. More than half of the cancer were diagnosed within two years before or after CTEPH diagnosis. Twenty-seven patients died during the study period. Among them, 13 (48%) and 7 (26%) died of cancer and right heart failure, respectively. The 5-year survival rate was lower in the cancer group than in the non-cancer group (67.8% vs. 94.5%, p < 0.001). In the active cancer group, the 5-year survival rate was also lower than that in the non-active cancer and non-cancer groups (52.0% vs. 99.5%, p < 0.001 and 52.0% vs. 92.3%, p < 0.001, respectively). Multivariate Cox hazard analysis revealed that hemodialysis (p < 0.001) and cancer (p < 0.001) were independently associated with poor survival.
Patients with CTEPH rarely die of right heart failure, even if hemodynamically severe at diagnosis in the modern management era. However, patients with CTEPH frequently have comorbid cancer, which may be a strong prognostic factor.
在可进行球囊肺动脉血管成形术（BPA）和有获批药物后，慢性血栓栓塞性肺动脉高压（CTEPH）的预后有所改善。然而，癌症作为CTEPH的相关合并症之一，其临床影响仍不明确。我们旨在研究CTEPH合并癌症患者的预后情况。
回顾性分析2011年1月至2022年12月期间连续接受肺动脉内膜剥脱术、BPA或药物治疗的264例CTEPH患者的数据。根据截至2022年12月是否合并癌症，将患者分为癌症组（n = 47）和非癌症组（n = 217）。在癌症组中，分别有30例（64%）和17例（36%）患者被确定为患有活动性癌症和非活动性癌症。
两组之间的基线特征、血流动力学和治疗情况相似。超过一半的癌症是在CTEPH诊断前后两年内确诊的。27例患者在研究期间死亡。其中，分别有13例（48%）和7例（26%）死于癌症和右心衰竭。癌症组的5年生存率低于非癌症组（67.8%对94.5%，p < 0.001）。在活动性癌症组中，5年生存率也低于非活动性癌症组和非癌症组（分别为52.0%对99.5%，p < 0.001；52.0%对92.3%，p < 0.001）。多因素Cox风险分析显示，血液透析（p < 0.001）和癌症（p < 0.001）与不良生存独立相关。
在现代治疗时代，即使CTEPH患者诊断时血流动力学严重，也很少死于右心衰竭。然而，CTEPH患者常合并癌症，这可能是一个强有力的预后因素。
