[1]王帅 高睿媛 刘飞 夏云龙.具有潜在VEGF抑制剂适应证的甲状腺癌及肝癌患者心血管疾病分布的横断面调查研究[J].心血管病学进展,2021,(11):1040-1045.[doi:10.16806/j.cnki.issn.1004-3934.2021.11.000]
　WANG ShuaiGAO Ruiyuan,LIU Fei,XIA Yunlong.Distribution of Cardiovascular Comorbidities in Thyroid Cancer and Hepatocellular Carcinoma Patients with Potential Indications for VEGF Inhibitors[J].Advances in Cardiovascular Diseases,2021,(11):1040-1045.[doi:10.16806/j.cnki.issn.1004-3934.2021.11.000]
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具有潜在VEGF抑制剂适应证的甲状腺癌及肝癌患者心血管疾病分布的横断面调查研究()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2021年11期
页码:
1040-1045
栏目:
论著
出版日期:
2021-11-25

文章信息/Info

Title:
Distribution of Cardiovascular Comorbidities in Thyroid Cancer and Hepatocellular Carcinoma Patients with Potential Indications for VEGF Inhibitors
文章编号:
202105106
作者:
王帅 高睿媛 刘飞 夏云龙
(大连医科大学附属第一医院心血管内科,辽宁 大连 116011)
Author(s):
WANG ShuaiGAO Ruiyuan; LIU Fei; XIA Yunlong
(Department of Cardiology,The First Affiliated Hospital of Dalian Medical University,Dalian 116011,Liaoning,China)
关键词:
甲状腺癌; 肝癌; 心血管疾病; 高血压; 血管内皮生长因子
Keywords:
Thyroid cancer;  Hepatocellular carcinoma;  Cardiovascular disease;  Hypertension; Vascular endothelial growth factor
DOI:
10.16806/j.cnki.issn.1004-3934.2021.11.000
摘要:
目的 众多研究发现血管内皮生长因子（VEGF）抑制剂的应用增加了甲状腺癌及肝癌患者继发心血管疾病的风险，但对该类癌症患者在启动化疗前心血管疾病基线资料的研究却鲜有报道。本研究旨在探讨具有潜在VEGF抑制剂适应证的甲状腺癌及肝癌患者在启动抗癌治疗前心血管相关合并症的分布情况。方法 本研究回顾性纳入2015年1月1日—2020年12月31日就诊于大连医科大学附属第一医院，并且首次诊断为甲状腺癌或肝癌的患者，收集两组的基线资料、心血管合并症及危险因素等。结果 最终共纳入3 247例甲状腺癌或肝癌患者，两类癌症患者在应用VEGF抑制剂前已合并较高的心血管疾病风险，主要为高血压、冠状动脉粥样硬化性心脏病（冠心病）、心房颤动和心力衰竭。其中患病率最高的是高血压，且甲状腺癌患者中高血压的患病率（23.2%）略低于肝癌患者（25.2%），冠心病、心房颤动和心力衰竭的患病率在两组中无明显差异。从心血管疾病相关的危险因素来看，血脂代谢紊乱的患者占比十分显著（59.7%），其余危险因素占比从高到低依次为吸烟（24.9%）、饮酒（19.3%）及糖尿病（16.1%）。高血压患者中Ⅲ级（76.5%）及心血管风险分层为很高危（85.7%）的患者占比最多。患有高血压的癌症患者合并尿酸和肌酐增高，同时诊断为冠心病及心房颤动的风险均显著增高（P＜0.05）。有34.5%的甲状腺癌或肝癌患者在启动化疗前未达到目标血压。结论 在启用VEGF抑制剂前，甲状腺癌及肝癌患者已合并较高的心血管疾病风险，其中高血压最为常见。与不合并高血压患者相比，合并高血压的癌症患者多合并其他心血管疾病及心血管疾病相关危险因素，然而相当一部分高血压患者的血压控制未达推荐标准，这在未来可能限制VEGF抑制剂的使用及治疗效果。
Abstract:
Objective Numerous studies have found that the use of endothelial growth factor(VEGF) inhibitors increases the risk of secondary cardiovascular disease(CVD) in t hyroid cancer(TC) and hepatocellular carcinoma(HCC) patients. However,the distribution of CVD comorbidities in cancer patients at baseline before initiation of chemotherapy is rarely reported. The purpose of this study was to investigate the distribution of CVD comorbidities in TC and HCC patients before the 基金项目：辽宁省“兴辽英才计划”项目（XLYC2002096）通信作者：夏云龙，E-mail:yunlong_xia@126.cominitiation of anticancer therapy. Methods A total of 3 247 newly diagnosed with TC or HCC patients registered from 1 January 2015 to 31 December 2020 were included. Baseline data,CVD comorbidities and CVD risk factors were retracted for medical records. Results A total of 3 247 cases of TC and HCC patients were included,and they carried a high burden of CVD-related comorbidities before application of VEGF inhibitors,mainly hypertension,coronary heart disease(CHD),atrial fibrillation and heart failure. The highest prevalence was hypertension,and the prevalence of hypertension in HCC patients was slightly higher than TC patients(25.2% vs 23.2%, P=0.211). However,the prevalence rates of CHD,atrial fibrillation and heart failure were not significantly different between the two groups. In terms of risk factors associated with CVD,the prevalence of lipid metabolic disorders was significant(59.7%). The other risk factors were smoking(24.9%),alcohol consumption(19.3%) and diabetes(16.1%). In this study,hypertension patients with grade Ⅲ and very high CVD risk level account 76.5% and 85.7% respectively. Age and sex-adjusted binary logistic regression showed that HCC and TC cancer patients with high blood pressure had significant increase in the risk of combined co-prevalence of increased uric acid,creatinine,CHD and atrial fibrillation. Among the patients with hypertension,34.5% did not reach the target blood pressure. Conclusions TC and HCC patients were associated with a high risk of CVD before the application of VEGF antagonists,including hypertension,CHD,atrial fibrillation,and heart failure. Hypertension was the most common comorbidity. TC and HCC patients with hypertension patients have a higher risk of co-prevalence of other CVD and related risk factors. However,a considerable number of hypertension patients do not meet the recommended standard for blood pressure control,this may limit the use of VEGF inhibitors and the therapeutic effect in the future.

参考文献/References:



[1] Llovet JM,Ricci S,Mazzaferro V,et al. Sorafenib in advanced hepatocellular carcinoma[J]. N Engl J Med,2008,359(4):378-390.

[2] Wells SA Jr,Robinson BG,Gagel RF,et al. Vandetanib in patients with locally advanced or metastatic medullary thyroid cancer:a randomized,double-blind phase Ⅲ trial[J]. J C lin Oncol,2012,30(2):134-141.

[3] Touyz RM,Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy[J]. NPJ Precis Oncol,2018,2:13.

[4] Schmidinger M. Understanding and managing toxicities of vascular endothelial growth factor(VEGF) inhibitors[J]. EJC Suppl,2013,11(2):172-191.

[5] Wulkersdorfer B,Zeitlinger M,Schmid M. Pharmacokinetic aspects of vascular endothelial growth factor tyrosine kinase inhibitors[J]. Clin Pharmacokinet,2016,55(1):47-77.

[6] Johnson CB,Davis MK,Law A,et al. Shared risk factors for cardiovascular disease and cancer:implications for preventive health and clinical care in oncology patients[J]. Can J Cardiol,2016,32(7):900-907.

[7] Lyon AR,Dent S,Stanway S,et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies:a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society[J]. Eur J Heart Fail,2020,22(11):1945-1960.

[8] Williams B,Mancia G,Spiering W,et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension[J]. Eur Heart J,2018,39(33):3021-3104.

[9] Joint Committee for Guideline Revision. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension—A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension[J]. J Geriatr Cardiol,2019,16(3):182-241.

[10] Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program(NCEP) Expert Panel on Detection,Evaluation,And Treatment of High Blood Cholesterol In Adults(Adult Treatment Panel Ⅲ)[J]. JAMA,2001,285(19):2486-2497.

[11] Pearson TA,Palaniappan LP,Artinian NT,et al. American Heart Association Guide for Improving Cardiovascular Health at the Community Level,2013 update:a scientific statement for public health practitioners,healthcare providers,and health policy makers[J]. Circulation,2013,127(16):1730-1753.

[12] Miller KD,Nogueira L,Mariotto AB,et al. Cancer treatment and survivorship statistics,2019 [J]. CA Cancer J Clin,2019,69(5):363-385.

[13] Koene RJ,Prizment AE,Blaes A,et al. Shared risk factors in cardiovascular disease and cancer[J]. Circulation,2016,133(11):1104-1114.

[14] Curigliano G,Cardinale D,Dent S,et al. Cardiotoxicity of anticancer treatments:epidemiology,detection,and management[J]. CA Cancer J Clin,2016,66(4):309-325.

[15] Wang Z,Chen Z,Zhang L,et al. Status of Hypertension in China: Results From the China Hypertension Survey,2012-2015[J]. Circulation,2018,137(22):2344-2356.

[16] Milan A,Puglisi E,Ferrari L,et al. Arterial hypertension and cancer[J]. Int J Cancer,2014,134(10):2269-2277.

[17] Faruque LI,Lin M,Battistella M,et al. Systematic review of the risk of adverse outcomes associated with vascular endothelial growth factor inhibitors for the treatment of cancer[J]. PLoS One,2014,9(7):e101145.

[18] Seo JH,Kim YD,Park CS,et al. Hypertension is associated with oral,laryngeal,and esophageal cancer:a nationwide population-based study[J]. Sci Rep,2020,10(1):10291.

[19] Kasmari AJ,Welch A,Liu G,et al. Independent of cirrhosis,hepatocellular carcinoma risk is increased with diabetes and metabolic syndrome[J]. Am J Med,2017,130(6):746.e1-746.e7.

[20] Baradaran A,Nasri H,Rafieian-Kopaei M. Oxidative stress and hypertension:possibility of hypertension therapy with antioxidants[J]. J Res Med Sci,2014,19(4):358-367.

[21] Calle EE,Kaaks R. Overweight,obesity and cancer:epidemiological evidence and proposed mechanisms[J]. Nat R ev Cancer,2004,4(8):579-591.

[22] Mossenta M,Busato D,Dal Bo M,et al. Glucose metabolism and oxidative stress in hepatocellular carcinoma:role and possible implications in novel therapeutic strategies[J]. Cancers(Basel),2020,12(6):1668.

[23] Berta E,Lengyel I,Halmi S,et al. Hypertension in thyroid disorders[J]. Front Endocrinol(Lausanne),2019,10:482.

[24] Koene RJ,Prizment AE,Blaes A,et al. Shared risk factors in cardiovascular disease and cancer[J]. Circulation,2016,133(11):1104-1114.

[25] Maitland ML,Bakris GL,Black HR,et al. Initial assessment,surveillance,and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors[J]. J Natl Cancer Inst,2010,102(9):596-604.

备注/Memo

备注/Memo:

基金项目： 辽宁省“兴辽英才计划”项目 （ X LYC2002096 ）

通 信 作者： 夏云龙，E - mail :yunlong_xia@126.com

收稿日期：2021-05-24
更新日期/Last Update: 2021-12-06