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

Distribution of Cardiovascular Comorbidities in Thyroid Cancer and Hepatocellular Carcinoma Patients with Potential Indications for VEGF Inhibitors

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3247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。

Objective Numerous studies have found that the use of endothelial growth factor(VEGF)inhibitors increases the risk of secondary cardiovascular disease(CVD)in thyroid 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 initiation of anticancer therapy.Methods A total of 3247 newly diagnosed with TC or HCC patients registered from January 1,2015 to December 31,2020 were included.Baseline data,CVD comorbidities and CVD risk factors were retracted for medical records.Results A total of 3247 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 atherosclerotic heart disease(CHD),atrial fibrillation and heart failure.The highest prevalence was hypertension,and the prevalence of hypertension in TC patients was slightly lower than HCC patients(23.2%vs 25.2%).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 gradeⅢand very high CVD risk level account 76.5%and 85.7%respectively.Cancer patients with hypertension were associated with increased uric acid and creatinine,and the risk of CHD and atrial fibrillation was significantly higher(P<0.05).Among the TC or HCC patients with hypertension,34.5%did not reach the target blood pressure.Conclusion TC and HCC patients were associated with a high risk of CVD before the application of VEGF inhibitors,and hypertension was the most common comorbidity.TC and HCC patients with hypertension have a higher risk of co-prevalence of other CVD and related risk factors comparing with patients without hypertension.However,a considerable number of hypertension patients do not meet the recommended standard for blood pressure control,and this may limit the use of VEGF inhibitors and the therapeutic effect in the future.