Mennander Ari, Nielsen Susanne J, Skyttä Tanja, Landenhed Smith Maya, Martinsson Andreas, Pivodic Aldina, Hansson Emma C, Jeppsson Anders
Faculty of Medicine and Health Technology, Tampere, University, Tampere, Finland.
Department of Cardiothoracic Surgery, Tampere University Hospital, Heart Hospital, Finland.
Eur J Cardiothorac Surg. 2025 Mar 28;67(4). doi: 10.1093/ejcts/ezaf110.
It has been suggested that long-term risk for incident cancer is increased in patients operated with cardiopulmonary bypass. We compared the risk for incident cancer and cancer-specific death between patients undergoing coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass.
All patients without a history of cancer undergoing first-time CABG in Sweden during 1997-2020 were included in a nationwide population-based observational cohort study. Individual patient data from the SWEDEHEART registry and 4 other mandatory national registries were merged. The incidence of new cancer was compared between patients operated with or without cardiopulmonary bypass using multivariable Cox proportional hazards regression models adjusted for baseline characteristics, co-morbidities, socioeconomic factors and time of surgery. A propensity score-matched analysis with 3735 well-balanced pairs was also performed.
A total of 81 097 patients undergoing CABG with (n = 77 345) and without cardiopulmonary bypass (n = 3752) were included. Median follow-up was 8.2 (interquartile range 4.0-13.2) years. The crude event rates were 2.71 and 2.68 per 100 person-years in the patients operated with and without cardiopulmonary bypass, respectively. There was no difference in the adjusted risk for cancer between the groups [adjusted hazard ratio 0.95 (95% confidence interval; CI 0.90-1.01)] or in the risk for cancer-specific death between the groups [adjusted hazard ratio 0.99 (95% CI 0.89-1.09)]. The propensity score-matched analysis showed similar results [hazard ratio 0.96 (95% CI 0.89-1.04) and 0.99 (95% CI 0.85-1.13)], respectively.
Cardiopulmonary bypass is not associated with an increased risk of incident cancer or cancer-specific mortality in patients undergoing CABG.
有人提出，接受体外循环手术的患者发生癌症的长期风险会增加。我们比较了接受冠状动脉搭桥术（CABG）时使用和不使用体外循环的患者发生癌症及癌症特异性死亡的风险。
1997年至2020年期间在瑞典首次接受CABG且无癌症病史的所有患者被纳入一项基于全国人群的观察性队列研究。将来自瑞典心脏注册中心（SWEDEHEART）和其他4个国家强制注册中心的个体患者数据进行合并。使用针对基线特征、合并症、社会经济因素和手术时间进行调整的多变量Cox比例风险回归模型，比较使用或不使用体外循环进行手术的患者中新发癌症的发病率。还进行了倾向评分匹配分析，形成3735对平衡性良好的配对。
总共纳入了81097例接受CABG的患者，其中使用体外循环的患者有77345例，未使用体外循环的患者有3752例。中位随访时间为8.2年（四分位间距4.0 - 13.2年）。使用和未使用体外循环进行手术的患者中，粗事件发生率分别为每100人年2.71例和2.68例。两组之间调整后的癌症风险[调整后风险比0.95（95%置信区间；CI 0.90 - 1.01）]或癌症特异性死亡风险[调整后风险比0.99（95% CI 0.89 - 1.09）]没有差异。倾向评分匹配分析显示了类似的结果[风险比分别为0.96（95% CI 0.89 - 1.04）和0.99（95% CI 0.85 - 1.13）]。
在接受CABG的患者中，体外循环与发生癌症或癌症特异性死亡率增加无关。
