Competing risk analysis of cardiovascular death in patients with primary gallbladder cancer

Chen, Chong; Xu, Fengshuo; Yuan, Shiqi; Zhao, Xuenuo; Qiao, Mengmeng; Han, Didi; Lyu, Jun

doi:10.1002/cam4.5104

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…This is consistent with recent studies reporting increased CVD risk in bladder cancer, osteosarcoma, gallbladder cancer, colorectal cancer, and lymphoma. [ 25 , 30 , 46 – 48 ] Although the SMR was lowest in the elderly group, it was still higher 7 th an in the general elderly population. The reason for the higher SMR in the elderly group may be attributed to their poorer health, reduced immunity, and increased prevalence of comorbidities, including infections.…”

Section: Discussionmentioning

confidence: 94%

“…Moreover, the SEER database is freely available to the public and does not require informed patient consent or institutional review board approval. [ 25 ] The data for this research was obtained from the SEER database downloads (version 8.4.0.1) using the SEER*Stat software, which included information on HCC patients diagnosed between 2000 and 2014. This investigation extracted cardiovascular mortality data for the general population from 2000 to 2014 from the Centers for Disease Control and Prevention and then compared with cardiovascular mortality for patients with HCC to calculate standardized mortality rates (SMRs: [number of observed deaths/expected deaths] × 100%).…”

Section: Methodsmentioning

confidence: 99%

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Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

Cao,

Wang,

Yan

et al. 2023

Medicine

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Clinical data has shown that cardiovascular diseases (CVDs) have emerged as a prominent cause of mortality in individuals with hepatocellular carcinoma (HCC). This research aimed to reveal the comorbid effects of CVDs in patients with HCC. The cardiovascular mortality of patients diagnosed with HCC between 2000 and 2014 was compared to that of the general US population. Standardized mortality ratios were calculated to quantify the relative risk of cardiovascular mortality in HCC patients. The cumulative incidence of cardiovascular death (CVD) was estimated using Fine-Gray testing, and independent risk factors for CVD were determined using competing risk models. The results were analyzed using the Kaplan–Meier analysis. The overall SMR for CVD in HCC patients was 11.15 (95% CI: 10.99–11.32). The risk of CVD was significantly higher in patients aged < 55 years (SMR: 56.19 [95% CI: 54.97–57.44]) compared to those aged ≥ 75 years (SMR: 1.86 [95% CI: 1.75–1.97]). This study suggests that patients with HCC are at significant risk of developing CVD. Competing risk analyses indicated that age, grade, tumor size, surveillance, epidemiology, and end results stage, and surgical status were independent risk factors for CVD in patients with HCC. Therefore, patients with HCC require enhanced preventive screening and management of CVDs during and after treatment to improve patient survival.

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Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

Cao,

Wang,

Yan

et al. 2023

Medicine

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“…When categorizing tumor size, the risk of CVD death in HCC patients increases as tumor size increases. Recent studies have shown an inverse association between tumor size and CVD death[ 39 , 40 ]. The findings of this analysis suggest that HCC patients undergoing surgery have a significantly lower risk of CVD death.…”

Section: Discussionmentioning

confidence: 99%

Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

Zhang,

Liu,

Liu

et al. 2024

World J Gastrointest Oncol

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BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common types of cancers worldwide, ranking fifth among men and seventh among women, resulting in more than 7 million deaths annually. With the development of medical technology, the 5-year survival rate of HCC patients can be increased to 70%. However, HCC patients are often at increased risk of cardiovascular disease (CVD) death due to exposure to potentially cardiotoxic treatments compared with non-HCC patients. Moreover, CVD and cancer have become major disease burdens worldwide. Thus, further research is needed to lessen the risk of CVD death in HCC patient survivors. AIM To determine the independent risk factors for CVD death in HCC patients and predict cardiovascular mortality (CVM) in HCC patients. METHODS This study was conducted on the basis of the Surveillance, Epidemiology, and End Results database and included HCC patients with a diagnosis period from 2010 to 2015. The independent risk factors were identified using the Fine-Gray model. A nomograph was constructed to predict the CVM in HCC patients. The nomograph performance was measured using Harrell’s concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and area under the ROC curve (AUC) value. Moreover, the net benefit was estimated via decision curve analysis (DCA). RESULTS The study included 21545 HCC patients, of whom 619 died of CVD. Age (< 60) [1.981 (1.573-2.496), P < 0.001], marital status (married) [unmarried: 1.370 (1.076-1.745), P = 0.011], alpha fetoprotein (normal) [0.778 (0.640-0.946), P = 0.012], tumor size (≤ 2 cm) [(2, 5] cm: 1.420 (1.060-1.903), P = 0.019; > 5 cm: 2.090 (1.543-2.830), P < 0.001], surgery (no) [0.376 (0.297-0.476), P < 0.001], and chemotherapy(none/unknown) [0.578 (0.472-0.709), P < 0.001] were independent risk factors for CVD death in HCC patients. The discrimination and calibration of the nomograph were better. The C-index values for the training and validation sets were 0.736 and 0.665, respectively. The AUC values of the ROC curves at 2, 4, and 6 years were 0.702, 0.725, 0.740 in the training set and 0.697, 0.710, 0.744 in the validation set, respectively. The calibration curves showed that the predicted probabilities of the CVM prediction model in the training set vs the validation set were largely consistent with the actual probabilities. DCA demonstrated that the prediction model has a high net benefit. CONCLUSION Risk factors for CVD death in HCC patients were investigated for the first time. The nomograph served as an important reference tool for relevant clinical management decisions.

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“…As an essential biological, social, and psychological event, marriage has also been found to be associated with cardiovascular outcomes in multiple cancers ( 21 , 22 ). In our study, unmarried patients had a higher considerable risk of CVD, which was consistent with the result obtained after PSM.…”

Section: Discussionmentioning

confidence: 99%

Competing risk analysis of cardiovascular mortality in multiple myeloma survivors

Chen,

Guo,

Lin

et al. 2023

Transl Cancer Res

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Background The survival of multiple myeloma (MM) patients has significantly improved, and several factors increase the risk of cardiovascular death (CVD) mortality in MM. This study aims to determine the prognostic significance of factors associated with long-term CVD risk in MM survivors. Methods The data of MM survivors whose survival time was longer than 36 months were retrieved from the Surveillance, Epidemiology, and End Result (SEER) database between 2000 and 2015. Cox proportional hazards regressions and competing risk survival analyses were utilized to assess the CVD-associated risk factors. Propensity score matching (PSM) was further conducted to ensure the comparability of cardiovascular risk factors. The nomogram was based on these epidemiological factors to estimate individualized CVD probabilities for MM survivors, and its performance was assessed by Harrell’s concordance index (C-index) and calibration curve. Results A total of 32,528 survivors with MM were enrolled, and 2,061 (6.34%) suffered from CVD. In Cox proportional hazards regressions and competing risk survival analyses, age, period of diagnosis, sex, race, married status, income, chemotherapy, and radiotherapy were the independent risk factors for CVD. After PSM, there was a significant difference in cumulative incidence curves, using a competing-risks method, between the following matched groups: male vs. female group, white vs. non-white group, married vs. unmarried group, income <$75,000 vs. income ≥$75,000 group, chemotherapy vs. non-chemotherapy group, and radiotherapy vs. non-radiotherapy group. The nomogram predicted CVD probabilities with a training C-index of 0.700 and a validation C-index of 0.726. Calibration curves validated that the nomograms could accurately predict the CVD probabilities both in the training and validation group. Conclusions Among MM survivors, the mortality risk of cardiovascular diseases differs with age, sex, period at diagnosis, race/ethnicity, marital status, chemotherapy, and radiotherapy. Our nomograms, based on epidemiological variables, may be used to predict 5-, 10-, and 15-year cardiovascular disease outcomes of MM survivors.

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Competing risk analysis of cardiovascular death in patients with primary gallbladder cancer

Cited by 8 publications

References 29 publications

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

Competing risk analysis of cardiovascular mortality in multiple myeloma survivors

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