Huang Wen-Bo, Lai Heng-Zhou, Long Jing, Ma Qiong, Fu Xi, You Feng-Ming, Xiao Chong
TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Institute of Oncology, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
BMC Cancer. 2025 Mar 31;25(1):579. doi: 10.1186/s12885-025-13956-w.
The prognostic significance of vagal nerve (VN) activity, as measured by heart rate variability (HRV) in cancer patients remains a subject of debate. The aim of this meta-analysis was to evaluate the association between various HRV parameters and cancer prognosis.
We conducted an extensive search of the PubMed, Embase, Cochrane, and Web of Science databases and compared the overall survival (OS) of cancer patients with high and low HRV. The data type was unadjusted hazard ratio (HR). Random or fixed-effects models were used to calculate the pooled HR along with the 95% Confidence Interval (CI). We used funnel plot analysis to evaluate potential publication bias.
A total of 11 cohort studies were included with 2539 participants. The methodological quality of the included studies is generally high. Compared with low standard deviation of normal-to-normal intervals (SDNN) group, higher SDNN was a protective factor for OS in patients with cancer (I = 66%, HR = 0.59, 95% CI: 0.46-0.75, P < 0.0001). Compared with low root mean square of successive differences (RMSSD) group. The prognostic value of RMSSD did not reach statistical significance (I = 0%, HR = 0.85, 95% CI: 0.70-1.03, P = 0.11). Among the frequency domain indicators, higher high-frequency power HRV (HF-HRV) and low-frequency power HRV (LF-HRV) were associated with significantly longer overall survival compared to the low HF-HRV and LF-HRV groups (I = 6%, HR = 0.59, 95% CI: 0.43-0.80, P = 0.006 and I = 74%, HR = 0.45, 95% CI: 0.22-0.93, P = 0.03). In the nonlinear indicators, higher maximal diagonal line length (Lmax), mean diagonal line length (Lmean), percent of recurrence (REC), and determinism (DET) were associated with poorer tumor OS. The funnel plot shows that there is no publication bias in the study.
The findings of this study demonstrate that HRV parameters, particularly SDNN, HF-HRV, and nonlinear indices, exhibit predictive value for prognosis in cancer. Furthermore, it can be inferred that elevated VN activity may predict prolonged survival outcomes. However, these findings should be interpreted with caution due to the heterogeneity observed across included studies. Future research should prioritize prospective studies with standardized measurement protocols to validate these associations.
通过心率变异性（HRV）测量的迷走神经（VN）活动在癌症患者中的预后意义仍存在争议。本荟萃分析的目的是评估各种HRV参数与癌症预后之间的关联。
我们对PubMed、Embase、Cochrane和Web of Science数据库进行了广泛检索，比较了HRV高和低的癌症患者的总生存期（OS）。数据类型为未调整的风险比（HR）。采用随机或固定效应模型计算合并HR以及95%置信区间（CI）。我们使用漏斗图分析来评估潜在的发表偏倚。
共纳入11项队列研究，2539名参与者。纳入研究的方法学质量总体较高。与正常到正常间期标准差（SDNN）低的组相比，较高的SDNN是癌症患者OS的保护因素（I=66%，HR=0.59，95%CI：0.46-0.75，P<0.0001）。与逐次差值均方根（RMSSD）低的组相比。RMSSD的预后价值未达到统计学意义（I=0%，HR=0.85，95%CI：0.70-1.03，P=0.11）。在频域指标中，与高频功率HRV（HF-HRV）和低频功率HRV（LF-HRV）低的组相比，较高的HF-HRV和LF-HRV与显著更长的总生存期相关（I=6%，HR=0.59，95%CI：0.43-0.80，P=0.006；I=74%，HR=0.45，95%CI：0.22-0.93，P=0.03）。在非线性指标中，较高的最大对角线长度（Lmax）、平均对角线长度（Lmean）、复发百分比（REC）和确定性（DET）与较差的肿瘤OS相关。漏斗图显示该研究中不存在发表偏倚。
本研究结果表明，HRV参数，特别是SDNN、HF-HRV和非线性指标，对癌症预后具有预测价值。此外，可以推断VN活动升高可能预测生存期延长。然而，由于纳入研究中观察到的异质性，这些发现应谨慎解释。未来的研究应优先进行采用标准化测量方案的前瞻性研究，以验证这些关联。
