鼻咽恶性肿瘤患者心血管疾病的死亡风险分析

A Population-based Study of Cardiovascular Disease Mortality Risk in Patients with Nasopharyngeal Cancer

目的分析鼻咽癌患者CVD死亡的风险及相关危险因素,为患者心血管疾病的危险分层、预防和早期干预提供依据。方法从监测、流行病学和最终结果(SEER)数据库中收集2000年至2020年间鼻咽癌患者数据。根据一般人群流行病学数据计算相对标准死亡风险比(standardized mortality ratio,SMR)。建立Nelson-Aalen独立累积风险曲线模型,分析相关危险因素。结果从SEER数据库中获得11395例鼻咽癌患者,在统一的纳入与排除标准后,其中380例患者发生CVD相关死亡;与一般人群相比,鼻咽癌患者CVD相关死亡风险较高。确诊时年龄0~49岁、种族为亚裔或太平洋岛民、离婚、鳞状细胞癌、远处转移肿瘤、未放疗、未化疗的患者有更高的死亡风险。动脉粥样硬化,其他动脉、小动脉和毛细血管疾病相关死亡风险更高。心脏病是导致死亡数目最多的CVD疾病。男性和女性患者群体CVD相关死亡风险基本持平。患者死亡数目最多的年龄段为55~64岁。Nelson-Aalen独立累积风险曲线显示CVD相关死亡风险随着诊断年龄的增加而逐渐增加。竞争风险预测因素研究中,年龄为危险因素,80岁以上风险比最高。黑人、男性、离婚、丧偶群体与CVD相关死亡的高风险独立相关。接受化疗群体与CVD相关死亡的低风险独立相关。结论与普通人群相比,鼻咽癌患者发生CVD相关死亡的风险明显增加。预先识别高危人群并采取心血管保护干预措施对有效提高患者生存率具有重要意义。

Objective To analyze the risk and related risk factors of CVD in patients with NPC,and provide evidence for risk stratification,prevention,and early intervention of CVD.Methods Collect patients with NPC from The Surveillance,Epidemiology,and End Results(SEER)database between 2000 and 2020.Calculate the Standardized Mortality Ratio(SMR)of patient with NPC to general population based on epidemiological data of the general population.Establish Nelson-Aalen independent cumulative risk models to study risk factors.Results 380 CVD deaths from 11,395 patients with NPC obtained from the SEER database.Compared to the general population,nasopharyngeal cancer patients have a higher risk of CVD related mortality.Diagnosed with NPC at the age of 0-49 years,divorce,pathological diagnosis of squamous cell carcinoma,tumor location on the inner wall and overlapping lesions,patients with distant metastasis during diagnosis,no radiotherapy and no chemotherapy had a higher risk of CVD related mortality.Heart disease was the CVD disease that causes the highest number of deaths.The risk of CVD related mortality is basically the same for both male and female patient populations.The age group with the highest number of deaths among patients between 55 and 64 years old.The Nelson-Aalen independent cumulative risk curve shows that the risk of CVD related mortality gradually increases with the age of diagnosis.In the competitive risk regression model,it was found that age was the risk variable,and age was positively correlated with hazard danger coefficient.The SMR is highest for patients over 80 years old;Black,male,divorced,and widowed populations are independently associated with a high risk of CVD related deaths.Chemotherapy was independently associated with a lower risk of CVD related mortality.Conclusion Patients with NPC have a significantly increased risk of CVD related mortality.Identifying high-risk populations in advance and implementing cardiovascular protection interventions is an important measure to effectively improve the survival rate of such patients.