2026 年第 2 期 第 21 卷

放疗对不同消化道恶性肿瘤患者心血管疾病死亡率的影响

Impact of radiotherapy on cardiovascular disease mortality in patients with different gastrointestinal malignant tumors

作者：玄昌波1吴焕林1牛佳龙2赵亦骢2刘颖初2刘晓丽2韩红亚2

英文作者：Xuan Changbo1 Wu Huanlin1， Niu Jialong2， Zhao Yicong2， Liu Yingchu2， Liu Xiaoli2， Han Hongya2

单位：1北京中医药大学第一临床医学院（东直门医院）心血管内科，北京100700；2首都医科大学附属北京安贞医院老年心血管病中心，北京100029

英文单位：1Department of Cardiovascular Medicine the First Clinical College of Beijing University of Chinese Medicine (Dongzhimen Hospital) Beijing 100700 China; 2Geriatric Cardiovascular Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：消化道恶性肿瘤；SEER数据库；心血管疾病死亡率；放疗

英文关键词：Gastrointestinalmalignanttumors;SEERdatabase;Cardiovasculardiseasemortality; Radiotherapy

• 摘要：

• 目的 探讨放疗对不同消化道恶性肿瘤患者心血管疾病死亡率的影响。方法 从美国国家癌症研究所监测、流行病学和最终结果数据库的大型队列中筛选出消化道恶性肿瘤的患者621 324例，通过泊松回归分析和Fine-Gray竞争风险回归分析，评估放疗对不同消化道恶性肿瘤患者心血管疾病死亡率的影响。同时进行亚组分析，识别放疗相关心血管疾病死亡的预测因素。结果 621 324例消化道恶性肿瘤患者中30 453例（4.9%）为食管癌，53 282例（8.6%）为胃癌，452 464例（72.8%）为结直肠癌，37 630例（6.1%）为肝细胞癌，7 979例（1.3%）为胆囊癌，39 516例（6.3%）为胰腺癌。在接受放疗的106 110例消化道肿瘤患者中，食管癌和胃癌患者的心血管疾病死亡风险显著升高（相对危险度=1.15，95%置信区间=1.03~1.28，校正后风险比=1.15，95%置信区间=1.06~1.29；相对危险度=1.19，95%置信区间=1.08~1.31，校正后风险比=1.11，95%置信区间=1.02~1.21）。与美国一般人群相比，接受放疗的食管癌患者心血管疾病死亡率的标准化死亡率最高。高龄、长病程、男性以及同时接受化疗的患者心血管死亡风险更高。结论 在消化道恶性肿瘤患者中，接受放疗的食管癌和胃癌患者心血管疾病死亡风险升高。高龄、长病程、男性以及同时接受化疗可能是消化道恶性肿瘤患者发生放疗相关心血管疾病死亡的潜在预测因素。

• Objective To investigate the impact of radiotherapy on cardiovascular disease mortality in patients with different gastrointestinal malignant tumors. Methods A total of 621 324 patients with gastrointestinal malignant tumors were screened from the large cohort of the Surveillance, Epidemiology, and End Results  database of the National Cancer Institute. Poisson regression analysis and Fine-Gray competing risk regression analysis were used to evaluate the impact of radiotherapy on cardiovascular disease mortality in patients with different gastrointestinal malignant tumors. Subgroup analysis was conducted simultaneously to identify the predictive factors of radiotherapy-related cardiovascular disease mortality. Results A total of 621 324 patients with gastrointestinal malignant tumors were enrolled, including 30 453 cases (4.9%) of esophageal cancer, 53 282 cases (8.6%) of gastric cancer, 452 464 cases (72.8%) of colorectal cancer, 37 630 cases (6.1%) of hepatocellular carcinoma, 7 979 cases (1.3%) of gallbladder cancer, and 39 516 cases (6.3%) of pancreatic cancer. Among the 106 110 patients with gastrointestinal tumors who received radiotherapy, the risk of cardiovascular disease mortality was significantly increased in patients with esophageal cancer and gastric cancer ［relative risk (RR)=1.15, 95% confidence interval (CI)=1.03-1.28, adjusted hazard ratio (HR)=1.15, 95%CI=1.06-1.29; RR=1.19, 95%CI=1.08-1.31, adjusted HR=1.11, 95%CI=1.02-1.21］. Compared with the general population in the United States, patients with esophageal cancer who received radiotherapy had the highest standardized mortality ratio of cardiovascular disease mortality. Advanced age, long disease course, male gender, and concurrent chemotherapy were associated with a higher risk of cardiovascular mortality. Conclusions Among patients with gastrointestinal malignant tumors, those with esophageal cancer and gastric cancer who receive radiotherapy have an increased risk of cardiovascular disease mortality. Advanced age, long disease course, male gender, and concurrent chemotherapy may be potential predictive factors for radiotherapy-related cardiovascular disease mortality in patients with gastrointestinal malignant tumors.