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353,273例不同肿瘤分期的结直肠肿瘤患者长期心血管死亡率：一项基于人群的大型研究
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Abstract:
目的：在肿瘤幸存者中，良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法：我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2014年、年龄超过15岁的结直肠肿瘤幸存者。心血管疾病的累积死亡率通过竞争风险模型进行估计。我们计算了结直肠肿瘤死亡患者中心血管疾病死亡的比例。将心血管疾病的标准化死亡率(Standardized mortality ratio, SMR)与美国普通人群进行比较。结果：共纳入353,273例患者，其中早期患者147,465例(41.7%)，中期患者141,541例(40.1%)，晚期患者64,267例(18.2%)。心血管疾病是所有患者的第二位死亡原因，是早期患者的第一位死亡原因。早期患者确诊后八年心血管疾病累积死亡率高于结直肠肿瘤(12.17%比11.76%，P < 0.001)。在不同肿瘤分期患者中，心血管疾病死亡比例逐渐超过结直肠肿瘤(总体：第七年30.57%比29.73%；早期：第五年30.91%比29.90%；中期：第九年34.14%比23.73%；晚期：第十二年28.83%比17.12%)。与美国普通人群相比，结直肠肿瘤患者心血管死亡率的SMR在诊断后一年内更高(早期：SMR为1.12，95%CI为1.07~1.17；中期：SMR为1.13，95%CI为1.08~1.18；晚期：SMR为1.84，95%CI为1.72~1.96)，年轻患者心血管疾病死亡的风险更高(早期：SMR为1.23，95%CI为0.90~1.64；中期：SMR为1.38，95%CI为1.02~1.83；晚期：SMR为4.19，95%CI为2.87~5.91)。结论：虽然心血管疾病在早期结直肠肿瘤患者中累积死亡率最高，但随着时间的推移，不同肿瘤分期的心血管疾病死亡风险均大于结直肠肿瘤。
Objective: Favorable prognoses are associated with an increased risk of death from cardiovascular disease (CVD) among cancer survivors. The objective of this study is to explore cumulative mortality and risk of death from cardiovascular disease in patients with colorectal cancer by tumor stages. Methods: We retrieved colorectal cancer survivors aged 15 years or older between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality from cardiovascular disease was estimated by competitive risk models. We calculated the proportions of death from cardiovascular disease among dead patients with colorectal cancer. Standardized mortality ratios (SMRs) for cardiovascular disease were estimated compared to the general US population. Results: A total of 353,273 patients were included, with 147,465 (41.7%) in the early stage, 141,541 (40.1%) in the middle stage, and 64,267 (18.2%) in the late stage. Cardiovascular disease was the second leading cause of death in all patients and the first leading cause of death in patients with localized disease. The cumulative mortality from cardiovascular disease was higher than that from colorectal cancer eight years after diagnosis in patients with localized disease (12.17% vs. 11.76%, P < 0.001). Among patients with different tumor stages, the proportion of deaths due to cardiovascular diseases gradually exceeds those due to colorectal cancer (overall: 30.57% vs 29.73% at the
| [1] | Siegel, R.L., Giaquinto, A.N. and Jemal, A. (2024) Cancer Statistics, 2024. CA: A Cancer Journal for Clinicians, 74, 12-49. https://doi.org/10.3322/caac.21820 |
| [2] | Wang, R., Han, L., Dai, W., Mo, S., Xiang, W., Li, Q., et al. (2020) Cause of Death for Elders with Colorectal Cancer: A Real-World Data Analysis. Journal of Gastrointestinal Oncology, 11, 269-276. https://doi.org/10.21037/jgo.2020.03.04 |
| [3] | Barish, R., Lynce, F., Unger, K. and Barac, A. (2019) Management of Cardiovascular Disease in Women with Breast Cancer. Circulation, 139, 1110-1120. https://doi.org/10.1161/circulationaha.118.039371 |
| [4] | Yin, J., Zhao, M., Lu, T., Huang, Y., Sui, Q., Xi, J., et al. (2019) Non-Lung Cancer Specific Mortality after Lobectomy or Sublobectomy in Patients with Stage IA Non-Small Cell Lung Cancer ≤ 2 cm: A Propensity Score Analysis. Journal of Surgical Oncology, 120, 1486-1496. https://doi.org/10.1002/jso.25724 |
| [5] | Wang, Q., Jiang, C., Zhang, Y., Zhang, Y., Yue, B., Zheng-Lin, B., et al. (2020) Cardiovascular Mortality among Chronic Myeloid Leukemia Patients in the Pre-Tyrosine Kinase Inhibitor (TKI) and TKI Eras: A Surveillance, Epidemiology and End Results (SEER) Analysis. Leukemia & Lymphoma, 61, 1147-1157. https://doi.org/10.1080/10428194.2019.1711074 |
| [6] | Wang, L., Wang, F., Chen, L., Geng, Y., Yu, S. and Chen, Z. (2020) Long-Term Cardiovascular Disease Mortality among 160 834 5-Year Survivors of Adolescent and Young Adult Cancer: An American Population-Based Cohort Study. European Heart Journal, 42, 101-109. https://doi.org/10.1093/eurheartj/ehaa779 |
| [7] | Sturgeon, K.M., Deng, L., Bluethmann, S.M., Zhou, S., Trifiletti, D.M., Jiang, C., et al. (2019) A Population-Based Study of Cardiovascular Disease Mortality Risk in US Cancer Patients. European Heart Journal, 40, 3889-3897. https://doi.org/10.1093/eurheartj/ehz766 |
| [8] | Afifi, A.M., Saad, A.M., Al‐Husseini, M.J., Elmehrath, A.O., Northfelt, D.W. and Sonbol, M.B. (2019) Causes of Death after Breast Cancer Diagnosis: A US Population‐based Analysis. Cancer, 126, 1559-1567. https://doi.org/10.1002/cncr.32648 |
| [9] | Surveillance, Epidemiology, and End Results (SEER) Program (2018) SEER*Stat Database: Incidence-SEER 18 Regs excluding AK Research Data, November 2017 Submission (2000-2015) for Standardized Mortality Ratios-Linked to County Attributes-Total U.S., 1969-2016 Counties. National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program. https://www.seer.cancer.gov |
| [10] | Brämer, G.R. (1988) International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. World Health Statistics Quarterly, 41, 32-36. |
| [11] | April Fritz, C.P., Jack, A., Shanmugaratnam, K., Sobin, L., Parkin, D.M. and Whelan, S. (2013) International Classification of Diseases for Oncology (ICD-O)—3rd Edition, 1st Revision. World Health Organization. |
| [12] | Thomas, D. and Koepsell, N.S.W. (2004) Epidemiologic Methods: Studying the Occurrence of Illness. Oxford University Press. |
| [13] | Strongman, H., Gadd, S., Matthews, A.A., Mansfield, K.E., Stanway, S., Lyon, A.R., et al. (2022) Does Cardiovascular Mortality Overtake Cancer Mortality during Cancer Survivorship? An English Retrospective Cohort Study. JACC: CardioOncology, 4, 113-123. https://doi.org/10.1016/j.jaccao.2022.01.102 |
| [14] | Cao, X., Zhang, L., Wang, X., Chen, Z., Zheng, C., Chen, L., et al. (2023) Cardiovascular Disease and All-Cause Mortality Associated with Individual and Combined Cardiometabolic Risk Factors. BMC Public Health, 23, Article No. 1725. https://doi.org/10.1186/s12889-023-16659-8 |
| [15] | Weiner, A.B., Li, E.V., Desai, A.S., Press, D.J. and Schaeffer, E.M. (2021) Cause of Death during Prostate Cancer Survivorship: A Contemporary, US Population-Based Analysis. Cancer, 127, 2895-2904. https://doi.org/10.1002/cncr.33584 |
| [16] | Gilchrist, S.C., Barac, A., Ades, P.A., Alfano, C.M., Franklin, B.A., Jones, L.W., et al. (2019) Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement from the American Heart Association. Circulation, 139, e997-e1012. https://doi.org/10.1161/cir.0000000000000679 |
| [17] | Weaver, K.E., Foraker, R.E., Alfano, C.M., Rowland, J.H., Arora, N.K., Bellizzi, K.M., et al. (2013) Cardiovascular Risk Factors among Long-Term Survivors of Breast, Prostate, Colorectal, and Gynecologic Cancers: A Gap in Survivorship Care? Journal of Cancer Survivorship, 7, 253-261. https://doi.org/10.1007/s11764-013-0267-9 |
| [18] | Søgaard, M., Thomsen, R.W., Bossen, K.S., Sørensen, H.T. and Nørgaard, M. (2013) The Impact of Comorbidity on Cancer Survival: A Review. Clinical Epidemiology, 5, 3-29. https://doi.org/10.2147/clep.s47150 |
| [19] | Siegel, R.L., Wagle, N.S., Cercek, A., Smith, R.A. and Jemal, A. (2023) Colorectal Cancer Statistics, 2023. CA: A Cancer Journal for Clinicians, 73, 233-254. https://doi.org/10.3322/caac.21772 |
| [20] | Fogarassy, G., Vathy-Fogarassy, Á., Kenessey, I., Veress, G., Polgár, C. and Forster, T. (2020) Preventing Cancer Therapy-Related Heart Failure: The Need for Novel Studies. Journal of Cardiovascular Medicine, 22, 459-468. https://doi.org/10.2459/jcm.0000000000001115 |
| [21] | Ewer, M.S. and Ewer, S.M. (2015) Cardiotoxicity of Anticancer Treatments. Nature Reviews Cardiology, 12, 547-558. https://doi.org/10.1038/nrcardio.2015.65 |
| [22] | Herrmann, J., Lenihan, D., Armenian, S., Barac, A., Blaes, A., Cardinale, D., et al. (2021) Defining Cardiovascular Toxicities of Cancer Therapies: An International Cardio-Oncology Society (IC-OS) Consensus Statement. European Heart Journal, 43, 280-299. https://doi.org/10.1093/eurheartj/ehab674 |
| [23] | Hershman, D.L., McBride, R.B., Eisenberger, A., Tsai, W.Y., Grann, V.R. and Jacobson, J.S. (2008) Doxorubicin, Cardiac Risk Factors, and Cardiac Toxicity in Elderly Patients with Diffuse B-Cell Non-Hodgkin’s Lymphoma. Journal of Clinical Oncology, 26, 3159-3165. https://doi.org/10.1200/jco.2007.14.1242 |
| [24] | Kenzik, K.M., Balentine, C., Richman, J., Kilgore, M., Bhatia, S. and Williams, G.R. (2018) New-Onset Cardiovascular Morbidity in Older Adults with Stage I to III Colorectal Cancer. Journal of Clinical Oncology, 36, 609-616. https://doi.org/10.1200/jco.2017.74.9739 |
| [25] | Kerr, D.J., Dunn, J.A., Langman, M.J., Smith, J.L., Midgley, R.S.J., Stanley, A., et al. (2007) Rofecoxib and Cardiovascular Adverse Events in Adjuvant Treatment of Colorectal Cancer. New England Journal of Medicine, 357, 360-369. https://doi.org/10.1056/nejmoa071841 |
| [26] | Lan, Y., Chang, S., Lin, P., Lin, C., Lin, H., Huang, S., et al. (2021) Clinicopathological and Molecular Features of Patients with Early and Late Recurrence after Curative Surgery for Colorectal Cancer. Cancers, 13, Article 1883. https://doi.org/10.3390/cancers13081883 |
| [27] | de Jong, M.C., Gaze, M.N., Szychot, E., Rozalén García, V., Brain, C., Dattani, M., et al. (2021) Treating Papillary and Follicular Thyroid Cancer in Children and Young People: Single UK-Center Experience between 2003 and 2018. Journal of Pediatric Surgery, 56, 534-539. https://doi.org/10.1016/j.jpedsurg.2020.07.034 |
| [28] | Weberpals, J., Jansen, L., Müller, O.J. and Brenner, H. (2018) Long-Term Heart-Specific Mortality among 347 476 Breast Cancer Patients Treated with Radiotherapy or Chemotherapy: A Registry-Based Cohort Study. European Heart Journal, 39, 3896-3903. https://doi.org/10.1093/eurheartj/ehy167 |
| [29] | Girardi, F., Franceschi, E. and Brandes, A.A. (2010) Cardiovascular Safety of VEGF-Targeting Therapies: Current Evidence and Handling Strategies. The Oncologist, 15, 683-694. https://doi.org/10.1634/theoncologist.2009-0235 |
| [30] | Wang, K., Eblan, M.J., Deal, A.M., Lipner, M., Zagar, T.M., Wang, Y., et al. (2017) Cardiac Toxicity after Radiotherapy for Stage III Non-Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 GY. Journal of Clinical Oncology, 35, 1387-1394. https://doi.org/10.1200/jco.2016.70.0229 |
| [31] | Wang, Y., Wang, Y., Han, X., Sun, J., Li, C., Adhikari, B.K., et al. (2022) Cardio-Oncology: A Myriad of Relationships between Cardiovascular Disease and Cancer. Frontiers in Cardiovascular Medicine, 9, Article 727487. https://doi.org/10.3389/fcvm.2022.727487 |
| [32] | Lloyd-Jones, D.M. (1998) Accuracy of Death Certificates for Coding Coronary Heart Disease as the Cause of Death. Annals of Internal Medicine, 129, 1020-1026. https://doi.org/10.7326/0003-4819-129-12-199812150-00005 |
| [33] | Guan, S., Zhang, X., Liu, H., Zhang, Y., Hou, C., Ji, X., et al. (2020) Is Functional Disability a Risk Equivalent to the Comorbidity of Multi-Vascular Risk Factors for Cardiovascular Events and All-Cause Death? A 5-Year Follow-Up Study. Topics in Stroke Rehabilitation, 27, 553-562. https://doi.org/10.1080/10749357.2020.1738661 |
| [34] | Cuthbert, C.A., Hemmelgarn, B.R., Xu, Y. and Cheung, W.Y. (2018) The Effect of Comorbidities on Outcomes in Colorectal Cancer Survivors: A Population-Based Cohort Study. Journal of Cancer Survivorship, 12, 733-743. https://doi.org/10.1007/s11764-018-0710-z |
