Variable cardiovascular risk factors is a risk factor for overall survival of patients with esophageal squamous cell carcinoma after surgery: a retrospective cohort study

Abstract

Background: Cardiovascular disease (CVD) and esophageal squamous cell carcinoma (ESCC) may share the same risk factors. The purpose of this study was to investigate the relationship between variable cardiovascular risk factors (CVRFs) and the prognosis of patients with ESCC. Methods: This was a retrospective study that included 315 patients with stage II or III ESCC treated with radical surgery in Fujian Provincial Hospital from June 2015 to December 2018. According to the number of CVRFs, patients were divided into low-CVRFs group (number of CVRFs≤2) and high-CVRFs group (number of CVRFs>2). The observation endpoint was all-cause mortality. Follow-up was up to December 31, 2021. Kaplan-Meier method and COX regression analysis were used to perform survival analysis. Results: The 315 patients were followed up for 1-78 months (median follow-up time 42 months). A total of 120 patients died by the follow-up date. The proportion of all-cause mortality was higher in the high-CVRFs group compared with the low-CVRFs group. Patients in the high-CVRFs group had a shorter survival time (p<0.05). After adjusting for conventional risk factors, diabetes, one of the CVRFs, was a risk factor for overall survival (OS) (HR 2.05, 95% CI 1.290-3.258, p=0.002). For each additional CVRF, the risk of all-cause mortality increases (HR 1.293, 95% CI 1.090-1.535, p=0.003). Similarly, among patients receiving chemotherapy or radiotherapy, there was an increased risk of all-cause mortality for each additional CVRF (HR 1.436, 95% CI 1.117-1.846, p=0.005 for chemotherapy; HR 1.761, 95% CI 1.335-2.322, p<0.001 for radiotherapy). Risk of all-cause mortality was higher in the high-CVRFs group compared to the low-CVRFs group (HR 1.636, 95% CI 1.101-2.431, p=0.015). High-CVRFs was a risk factor for OS in patients receiving chemotherapy or radiotherapy (HR 2.314, 95% CI 1.262-4.240, p=0.007 for chemotherapy; HR 3.336, 95% CI 1.781-6.251, p<0.001 for radiotherapy). Conclusions: Diabetes, as one of the CVRFs, was an independent risk factor for OS in patients with stage II or III ESCC treated with radical surgery. CVRFs were associated with poorer OS, especially in those receiving radiotherapy or chemotherapy.