头颈癌患者及幸存者的急性心肌梗死：一项基于人群的队列研究，探讨患者、疾病和治疗因素
Acute Myocardial Infarction in Head and Neck Cancer Patients and Survivors: A Population-Based Cohort Study of Patient, Disease, and Treatment Factors.
文献信息
| PMID | 42759388 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | H J Wong |
| 作者单位 | Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. |
| 期刊 | Clinical oncology (Royal College of Radiologists (Great Britain)) |
| SCI 分区 | Q3 |
| IF | 3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 头颈癌（HNC）日益被认为是一种具有长期血管和代谢并发症的系统性疾病。虽然脑血管风险已有描述，但HNC与急性心肌梗死（AMI）之间的关联仍较少被充分表征，特别是在患者、疾病和治疗相关因素方面。因此，我们旨在评估HNC患者与一般人群相比的AMI风险，并确定与风险增加相关的人口统计学、肿瘤和治疗特征。
材料与方法： 这项基于人群的回顾性队列研究使用了新加坡癌症登记处和新加坡心肌梗死登记处的数据。纳入2007年1月1日至2021年12月31日期间诊断的HNC患者，且既往无AMI。主要结局是HNC诊断后的新发AMI。风险通过与一般人群比较的年龄标准化发病率比（SIRR）和率差（SIRD）进行量化。进行了广泛的亚组分析，按年龄、性别、种族、肿瘤亚部位、组织学和治疗方式（手术、放疗、化疗或联合治疗）定义。
结果： 在9358例HNC患者中（中位年龄59岁；72%为男性），403例（4.3%）在中位随访3.7年期间发生AMI。10年累积发病率为5.4%。AMI风险高于一般人群（SIRR，2.35 [95%计算机断层扫描{CI}，2.13-2.59]；SIRD，每1000人年[PY] 5.06），在5年内最为显著（SIRR，5.07）。风险在单纯化疗和下咽癌中最高。
结论： HNC患者的AMI风险增加约两倍，尤其是在诊断后早期，支持心血管风险分层和心脏肿瘤学监测。
英文摘要
AIMS: Head and neck cancer (HNC) is increasingly recognized as a systemic disease with long-term vascular and metabolic complications. While cerebrovascular risks have been described, the association between HNC and acute myocardial infarction (AMI) remains less well characterized, particularly regarding patient-, disease-, and treatment-related factors. Hence, we sought to evaluate the risk of AMI among patients with HNC compared with the general population and to identify demographic, tumor, and treatment characteristics associated with increased risk.
MATERIALS AND METHODS: This population-based retrospective cohort study used data from the Singapore Cancer Registry and the Singapore Myocardial Infarction Registry. Individuals diagnosed with HNC between January 1, 2007, and December 31, 2021, without prior AMI were included. The primary outcome was incident AMI after HNC diagnosis. Risk was quantified using age-standardized incidence rate ratios (SIRRs) and rate differences (SIRDs) compared with the general population. Extensive subgroup analyses were conducted, defined by age, sex, ethnicity, tumor subsite, histology, and treatment modality (surgery, radiotherapy, chemotherapy, or combinations).
RESULTS: Among 9358 patients with HNC (median age, 59 years; 72% male), 403 (4.3%) developed AMI during a median follow-up of 3.7 years. The 10-year cumulative incidence was 5.4%. AMI risk was higher than in the general population (SIRR, 2.35 [95% computed tomography {CI}, 2.13-2.59]; SIRD, 5.06 per 1000 person-years [PY]), most pronounced within 5 years (SIRR, 5.07). Risk was highest with chemotherapy alone and hypopharyngeal cancer.
CONCLUSION: Patients with HNC have an approximately twofold increased AMI risk, particularly early after diagnosis, supporting cardiovascular risk stratification and cardio-oncology surveillance.