Zheng Yingying, Liu Zishen, Chen Dong, Zhang Jingzhi, Yuan Mengqi, Zhang Yutong, Liu Shiyu, Zhang Ganlin, Yang Guowang
Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Cardiovasc Toxicol. 2025 May;25(5):805-819. doi: 10.1007/s12012-025-09979-1. Epub 2025 Mar 7.
Immune checkpoint inhibitors (ICIs) have demonstrated favorable outcomes in various cancers. However, it has been observed that ICIs may induce life-threatening cardiovascular toxicity. In this study, a meta-analysis was conducted to determine the risk of cardiovascular toxicities in patients exposed to ICIs or in combination with chemotherapy. PubMed, Cochrane Library, and Embase databases were searched from inception to September 24, 2023. This study was conducted in accordance with the PRISMA guidelines. A meta-analysis was conducted on the risk of cardiotoxicity in cancer patients. Data were pooled with a random-effect model. This protocol was registered prospectively in PROSPERO (CRD42023467319). The primary outcome was cardiotoxicity risk in observational studies with ICIs or combined with chemotherapy. The risk factors that affected the occurrence of cardiovascular toxicities were also examined. ICIs or combined with chemotherapy increased the cardiotoxicity risk compared with mono-chemotherapy (OR 1.47; 95% CI 1.05-2.06, p = 0.024). The risk of pericardial disease in cardiotoxic events (OR 1.99; 95% CI 1.23-3.22, p = 0.005) and thromboembolic events (OR 1.34; 95% CI 1.04-1.72, p = 0.025) was significantly increased. Smoking (OR 1.25; 95% CI 1.12-1.39, p < 0.001), previous heart disease (OR 2.01; 95% CI 1.64-2.46, p < 0.001), and lung cancer (OR 1.46; 95% CI 1.26-1.69, p < 0.001) were risk factors worthy of attention. ICIs or combined with chemotherapy show an elevated risk of cardiovascular toxicities. Patients who are smoking, diagnosed lung cancer, and having prior medical history of heart diseases need more attention.
免疫检查点抑制剂（ICIs）已在多种癌症中显示出良好疗效。然而，据观察，ICIs可能会诱发危及生命的心血管毒性。在本研究中，进行了一项荟萃分析，以确定接受ICIs治疗或联合化疗的患者发生心血管毒性的风险。检索了PubMed、Cochrane图书馆和Embase数据库，检索时间从数据库创建至2023年9月24日。本研究按照PRISMA指南进行。对癌症患者心脏毒性风险进行了荟萃分析。数据采用随机效应模型进行汇总。本方案已在PROSPERO（CRD42023467319）中进行前瞻性注册。主要结局是在观察性研究中ICIs治疗或联合化疗的心脏毒性风险。还研究了影响心血管毒性发生的危险因素。与单纯化疗相比，ICIs治疗或联合化疗增加了心脏毒性风险（比值比[OR]1.47；95%置信区间[CI]1.05 - 2.06，p = 0.024）。心脏毒性事件中心包疾病风险（OR 1.99；95% CI 1.23 - 3.22，p = 0.005）和血栓栓塞事件风险（OR 1.34；95% CI 1.04 - 1.72，p = 0.025）显著增加。吸烟（OR 1.25；95% CI 1.12 - 1.39，p < 0.001）、既往心脏病史（OR 2.01；95% CI 1.64 - 2.46，p < 0.001）和肺癌（OR 1.46；95% CI 1.26 - 1.69，p < 0.001）是值得关注的危险因素。ICIs治疗或联合化疗显示出心血管毒性风险升高。吸烟、诊断为肺癌且有心脏病既往史的患者需要更多关注。
