Infective endocarditis and cancer in the elderly.
Infective endocarditis and cancer in the elderly.
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DOI：
10.1007/s10654-015-0111-9
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发表时间：
2016-01
影响因子：
13.6
通讯作者：
Hernán MA
中科院分区：
文献类型：
--
作者：
García-Albéniz X;Hsu J;Lipsitch M;Logan RW;Hernández-Díaz S;Hernán MA
感染性心内膜炎与癌症之间的关联程度，以及伴随感染性心内膜炎诊断的癌症患者的自然病史，我们知之甚少。我们使用SEER-Medicare链接数据库来识别在1992-2009年间被诊断患有结直肠癌、肺癌、乳腺癌或前列腺癌且没有任何癌症诊断的65岁或以上的个人(来自SEER地区的5%随机联邦医疗保险样本)。我们从MEDPAR档案中记录的每次入院的ICD-9诊断及其在癌症诊断前后90天的发病率中确定感染性心内膜炎。我们还估计了伴随诊断为感染性心内膜炎后的总存活率和结直肠癌特异性存活率。感染性心内膜炎的围诊期发病率分别为：结直肠癌19.8例/10万人月，肺癌5.7例/10万人月，乳腺癌1.9例/10万人月，前列腺癌4.1例/10万人月，非癌症人2.4例/10万人月。合并心内膜炎的I-III期结直肠癌患者两年总生存率为46.4%(95%CI为39.5%，54.5%)，未合并心内膜炎的患者为73.1%(95%CI为72.9%，73.3%)。在这一老年人群中，结直肠癌确诊前后感染性心内膜炎的发生率显著高于肺癌、乳腺癌和前列腺癌确诊前后。结直肠癌患者合并感染性心内膜炎的诊断与较短的生存期有关。
Little is known about the magnitude of the association between infective endocarditis and cancer, and about the natural history of cancer patients with concomitant diagnosis of infective endocarditis. We used the SEER-Medicare linked database to identify individuals aged 65 years or more diagnosed with colorectal, lung, breast, or prostate cancer, and without any cancer diagnosis (5% random Medicare sample from SEER areas) between 1992–2009. We identified infective endocarditis from the ICD-9 diagnosis of each admission recorded in the Medpar file and its incidence rate 90 days around cancer diagnosis. We also estimated the overall survival and CRC-specific survival after a concomitant diagnosis of infective endocarditis. The peri-diagnostic incidence of infective endocarditis was 19.8 cases per 100,000 person-months for CRC, 5.7 cases per 100,000 person-months for lung cancer, 1.9 cases per 100,000 person-months for breast cancer, 4.1 cases per 100,000 person-months for prostate cancer and 2.4 cases per 100,000 person-months for individuals without cancer. Two-year overall survival was 46.4% (95% CI 39.5, 54.5%) for stage I–III CRC patients with concomitant endocarditis and 73.1% (95% CI 72.9, 73.3%) for those without it. In this elderly population, the incidence of infective endocarditis around CRC diagnosis was substantially higher than around the diagnosis of lung, breast and prostate cancers. A concomitant diagnosis of infective endocarditis in patients with CRC diagnosis is associated with shorter survival.