Cardiovascular Mortality Risk among Patients with Gastroenteropancreatic Neuroendocrine Neoplasms: A Registry‐Based Analysis

Abstract

Background. This research is aimed to explore mortality patterns and quantitatively assess the risks of cardiovascular mortality (CVM) in patients with primary gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). Methods. We extracted data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with GEP-NENs between 2000 and 2015. The standardized mortality ratio (SMR) and the absolute excess risk were obtained based on the reference of the general US population. The cumulative incidence function curves were constructed for all causes of death. Predictors for CVM were identified using a multivariate competing risk model. Results. Overall, 42027 patients were enrolled from the SEER database, of whom 1598 (3.8%) died from cardiovascular disease (CVD). The SMR for CVM was 1.20 (95% CI: 1.14-1.26) among GEP-NEN patients. The cumulative mortality of CVD was the lowest among all causes of death, including primary cancer, other cancer, and other noncancer diseases. Furthermore, age at diagnosis, race, Hispanic origin, sex, marital status, year of diagnosis, grade, education level, region, SEER stage, primary site, surgery, and chemotherapy were identified as independent predictors of CVM in GEP-NEN patients. Conclusions. GEP-NEN patients have a significantly increased risk of CVM relative to the general population. Cardioprotective interventions might be considered a preferred method for these patients.

Cardiovascular-Specific Mortality among Gastrointestinal Stromal Tumor Patients: A Population-Based Analysis

“…Furthermore, multivariate competing risk analysis suggested that patients diagnosed at an older age were predisposed to die due to CVD (HR: 54.817, 95% CI: 27.075-110.985). Interestingly, the SMR of CVM was the highest when patients aged 18-49 (SMR, 15.91, 95% CI: 9.19-27.53), similar to the results reported by Sun et al [ 14 ]. We hypothesized that older patients were likely to suffer from worse overall health, decreased immunity, and increased comorbidities such as infection [ 28 ], so they might not have a sufficient life expectancy to develop and die of CVD.…”

“…Oh et al reported a 20-fold increase in cardiovascular mortality (CVM) in cancer patients from 2000 to 2016 in Korea [ 13 ]. The risk of CVM in gastroenteropancreatic neuroendocrine neoplasm patients was 1.2 times higher than that in the general US population [ 14 ]. Felix et al demonstrated that the risk of CVM in endometrial cancer patients was 8.8-fold higher compared to women in the general population [ 15 ].…”

Cardiovascular Mortality Risk in Patients with Bladder Cancer: A Population-Based Study

“…CVM was the primary endpoint of interest, defined by the following six CVDs in the SEER database: (1) diseases of the heart, (2) hypertension without heart disease, (3) cerebrovascular diseases, (4) atherosclerosis, (5) aortic aneurysm and dissection, (6) other diseases of the arteries, arterioles, and capillaries [ 10 , 11 ], while competing events were deaths from BC, other cancers, and other non-cancer diseases.…”

Cardiovascular Mortality among Patients with Pancreatic Cancer: A Population-based Study

“…To clearly describe the mortality of cardiovascular disease, the Fine-Gray sub-distribution hazard model was used in our current study over the follow-up months (up to 227 months), in which the crude cumulative incidence function (CIF) was applied to represent the probability of developing primary and competing events, and the univariate or the multivariable competing risk survival analyses were applied to select independent predictors of cardiovascular disease among patients with pancreatic cancer 15 . In our study, cardiovascular disease was illustrated as death due to the primary event of interest, and the remaining causes of death, such as pancreatic cancer, other cancer, and other non-cancer causes, were illustrated as death due to competing events.…”