Cardiovascular disease related death among patients with esophagus cancer: A population-based competing risk analysis

Abstract

The proportion of non-cancer death in patients with esophagus cancer (EC) still increasing, especially cardiovascular disease (CVD) related death. The aim of this study was assess non-cancer causes of death and identified independent risk factors of CVD related death in EC patients. Patients diagnosed with EC were extracted from the Surveillance, Epidemiology, and End Result database (SEER) database for analysis. Standardized mortality rates (SMRs) for non-EC deaths were calculated, the risk of death were assessed and compared with US general population. Multivariate competitive risk analysis were performed to select independent risk factors for death from CVD in EC patients. A total of 43739 EC patients were enrolled and 35139 died during follow-up, of which 4248 died from non-cancer cause of death. The risk of non-cancer death in EC patients was 2.27-fold higher than in the general population (SMR=2.27; 95% CI, 2.20-2.34). CVD were the most important cause of non-cancer death in EC patients, accounting for 43.4% of non-cancer of deaths. Compare with the general population, EC patients have higher risk of death from disease of heart (SMR, 2.24; 95% CI, 2.13-2.35), pneumonia and influenza (SMR, 2.92; 95% CI, 2.50-3.39), septicemia (SMR, 5.01; 95% CI, 4.30-5.79), along with other causes. Patients with advanced age and patients who received radiotherapy has higher risk of death caused by CVD, patients with female sex, poor differentiated and undifferentiated, regional and distant stage, married, diagnosed between 2010-2016 has lower risk of CVD related death, compared with patients without any treatment measures, patients received chemotherapy alone has lower risk of death from CVD. Non-cancer cause of death has become an important cause of death in EC patients. Improving public awareness of the major risk factors for non-cancer death is beneficial to the prevention and treatment of malignant tumors.

Non cancer causes of death after gallbladder cancer diagnosis: a population-based analysis

“…Therefore, the risk of postoperative cardiovascular events in GBC patients should be considered, such as the prevention of acute hypertension and arrhythmia in postoperative care. On the other hand, received chemotherapy were protective factor for non cancer death in our analysis, consistent with previous studies 39 , 46 , 47 . This does not seem to fit with the common belief that chemotherapy causes cardiotoxicity and increases the risk of CVD.…”

“…This does not seem to fit with the common belief that chemotherapy causes cardiotoxicity and increases the risk of CVD. This may be due to that patients who receive regular chemotherapy can receive better health monitoring during treatment and receive more timely intervention when at healthy risk to avoid subsequent adverse events 47 . However, the underlying mechanism why chemotherapy improves non cancer death outcomes in GBC patients has not been clarified, and further studies still needed.…”