Cardiovascular disease-specific mortality in 270,618 patients with non-small cell lung cancer

Sun, Jin‐Yu; Zhang, Zhen-Ye; Qu, Qiang; Wang, Ning; Miao, Ling-Feng; Wang, Ji; Wu, Li-Da; Liu, Ying; Changying, Zhang; Wang, Ruxing

doi:10.1016/j.ijcard.2021.02.025

Cited by 22 publications

(23 citation statements)

References 33 publications

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Section: Discussionmentioning

confidence: 99%

“…Cardiovascular-pulmonary disease is the leading nonrecurrence cause of death in NSCLC patients [ 6 ]. The cardiovascular system and lungs are among the organs that are most severely affected by RT injury, resulting in increased morbidity and mortality [ 6 , 16 , 18 ]. The mechanisms of RT-related cardiovascular disease include endothelial dysfunction, altered vascular tone, hemostatic imbalance, and inflammatory activation [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Early-stage NSCLC is best managed with complete surgical resection [ 3 ]. Despite curative-intent surgical resection, tumor recurrence and metastasis are major causes of death for patients with locally advanced NSCLC [ 4 – 6 ]. Therefore, surgery plus multidisciplinary sequential therapy continues to be the backbone of treatment with curative intent among patients with stage IIIA resected NSCLC [ 5 , 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Thoracic RT increases the risk of cardiovascular-pulmonary disease during or after therapy, such as ischemic heart disease, arterial disease, pericardial disease, vascular and metabolic issues, conduction disorders, pneumonitis and pulmonary fibrosis, chronic pulmonary insufficiency, and cor pulmonale, and resulting in increased mortality [ 6 , 16 – 20 ]. Radiation-associated cardiovascular-pulmonary events and deaths have been thoroughly documented in long-term survivors of breast cancer and Hodgkin’s lymphoma [ 18 , 21 – 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…Radiation-associated cardiovascular-pulmonary events and deaths have been thoroughly documented in long-term survivors of breast cancer and Hodgkin’s lymphoma [ 18 , 21 – 24 ]. However, the data regarding RT‐associated cardiovascular-pulmonary specific death in patients with NSCLC are limited [ 6 ]. Currently, there are no large datasets available with PORT and cardiovascular-pulmonary specific mortality in patients with stage IIIA-N2 NSCLC.…”

Section: Introductionmentioning

confidence: 99%

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Effects of postoperative radiotherapy on cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected NSCLC: analysis of the SEER database

et al. 2021

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Background The role of postoperative radiotherapy (PORT) in cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected non-small cell lung cancer (NSCLC) remains uncertain. The purpose of this population-based analysis was to explore the effect of PORT on cardiovascular-pulmonary disease mortality in these patients. Methods Patients aged ≥ 18 years with stage IIIA-N2 resected NSCLC were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and were grouped according to the use of PORT. Propensity score matching (PSM) was used to account for differences in baseline characteristics between the Non-PORT and PORT groups. The cumulative risk for cardiovascular-pulmonary disease death was estimated using the cumulative incidence curve. Competing risk regression was used to run univariate and multivariate analyses to evaluate risk factors. Results A total of 3981 patients were included in the study population. Among them, 1446 patients received PORT, and 2535 did not. A total of 1380 patients remained in each group after PSM, and the baseline characteristics were not significantly different between the two groups. The cumulative incidence of cardiovascular-pulmonary mortality was 10.93% in the Non-PORT group compared with 9.85% in the PORT group. There was no significant difference in the cumulative risk between the two groups (HR 1.07, 95% CI 0.77–1.48, p = 0.703). Multivariate analysis indicated that PORT had no significant impact on increased risk, with an HR of 1.18 (p = 0.377). Conclusions No significant differences between the PORT and Non-PORT groups were found in cardiovascular-pulmonary-specific modalities in this study. Further studies are required to validate these results. This study highlights the importance of long-term surveillance for NSCLC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of postoperative radiotherapy on cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected NSCLC: analysis of the SEER database

et al. 2021

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Dual effect of radiotherapy related concomitant cardiovascular diseases in non‐small cell lung cancer

Tian

et al. 2022

Cancer Medicine

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Background Nowadays, cancer and cardiac diseases are two of the most causes of death, so cancer treatment‐related cardiac death cannot be ignored. For lung cancer, chest radiotherapy (RT) is essential, but the related cardiotoxicity has not been fully studied. Methods We reviewed the data of 11,455 patients with non‐small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results database from 2001 to 2015. The change trend for concomitant cardiovascular diseases (CVD)‐specific death was calculated and graphically demonstrated. Univariate and multivariate analyses for survival were performed using Cox risk regression model. Results In our analysis, the overall incidence and mortality from NSCLC declined, but CVD‐specific death increased. Both chemoradiotherapy and radiotherapy alone played a significant role in CVD‐specific death. Analyzed longitudinally from diagnosis, we found that the effect of RT in CVD‐specific death increased continuously over the third years and the hazard ratio for CVD‐specific death was 1.386 times between RT and non‐RT group (HR = 1.386, 95% CI 1.322–1.452; p < 0.0001). On the other hand, RT played a protective role in CVD‐specific death before the second years, especially in recent years from 2013 to 2015 (HR = 0.843, 95% CI 0.740–0.959; p = 0.009). Conclusions Although the mortality from NSCLC decreased, but radiotherapy‐related CVD‐specific mortality cannot be ignored. In the long‐term over 3 years, RT significantly promoted CVD‐specific death. However, RT turned to be a protective role in the short‐term within 2 years. In clinical practice, we need to comprehensively consider the dual effects of radiotherapy on the side effect of heart.

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Age‐specific cardiovascular disease‐related mortality among patients with major gastrointestinal cancers: A SEER population‐based study

Liu

Zhang

2023

Cancer Medicine

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BackgroundStudies have reported age as a risk factor for cardiovascular disease (CVD)‐related mortality; however, only a few studies have focused on the relationship between age and CVD‐related mortality, especially among major gastrointestinal cancers.MethodThe present retrospective cohort enrolled patients with colorectal, pancreatic, hepatocellular, gastric, and esophageal cancer between 2000 to 2015 from the Surveillance, Epidemiology and End Results Registry (SEER). Standardized mortality ratio (SMR), competing risk regression, and restricted cubic spline (RCS) analyses were used in our study.ResultsWe analyzed 576,713 patients with major gastrointestinal cancers (327,800 patients with colorectal cancer, 93,310 with pancreatic cancer, 69,757 with hepatocellular cancer, 52,024 with gastric cancer, and 33,822 with esophageal cancer). Overall, CVD‐related mortality gradually decreased every year, and the majority were older patients. All cancer patients had a higher CVD‐related mortality rate than the general U.S. population. The adjusted sub‐hazard ratios for middle‐aged with colorectal cancer, pancreatic cancer, hepatocellular cancer, gastric cancer, and esophageal cancer were 2.55 (95% CI: 2.15–3.03), 1.77 (95% CI: 1.06–2.97), 2.64 (95% CI: 1.60–4.36), 2.15 (95% CI: 1.32–3.51), and 2.28 (95% CI: 1.17–4.44), respectively. The adjusted sub‐hazard ratios for older patients with colorectal cancer, pancreatic cancer, hepatocellular cancer, gastric cancer, and esophageal cancer were 11.23 (95% CI: 9.50–13.27), 4.05 (95% CI: 2.46–6.66), 4.47 (95% CI: 2.72–7.35), 7.16 (95% CI: 4.49–11.41), and 4.40 (95% CI: 2.28–8.48), respectively. A non‐linear relationship between age at diagnosis and CVD‐related mortality was found in colorectal cancer, pancreatic cancer, and esophageal cancer; their reference ages were 67, 69, and 66 years old, respectively.ConclusionThis study demonstrated that age was a risk factor for CVD‐related mortality among major gastrointestinal cancers.

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Cardiovascular disease-specific mortality in 270,618 patients with non-small cell lung cancer

Cited by 22 publications

References 33 publications

Effects of postoperative radiotherapy on cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected NSCLC: analysis of the SEER database

Effects of postoperative radiotherapy on cardiovascular-pulmonary disease mortality in patients with stage IIIA-N2 resected NSCLC: analysis of the SEER database

Dual effect of radiotherapy related concomitant cardiovascular diseases in non‐small cell lung cancer

Age‐specific cardiovascular disease‐related mortality among patients with major gastrointestinal cancers: A SEER population‐based study

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