Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis

Abstract

IntroductionPrimary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies. Geographic survival disparities have not been reported previously for PMCT and the aim of this study is to compare the prevalence and the long-term survival rate with respect to the geographic location of PMCTs using the Surveillance, Epidemiology, and End Results (SEER) research plus data 17 registries between 2000 and 2019.MethodsThe SEER database was queried to identify geographic variation among PMCTs. We classified the included states into 4 geographical regions (Midwest, Northeast, South and West regions) based on the U.S. Census Bureau-designated regions and divisions. Different demographic and clinical variables were analyzed and compared between the four groups. Kaplan Meier curves and Cox regression were used for survival assessment.ResultsA total of 563 patients were included in our analysis. The median age was 53 years (inter-quartile range (IQR): 38 - 68 years) and included 26, 90, 101, and 346 patients from the Midwest, Northeast, South, and West regions respectively. Sarcoma represented 65.6% of the cases, followed by hematological tumors (26.2%), while mesothelioma accounted for 2.1%. Treatment analysis showed no significant differences between different regions. Median overall survival was 11, 21, 13, and 11 months for Midwest, Northeast, South and West regions respectively and 5-year overall survival was 22.2%, 25.4%, 14.9%, and 17.6% respectively. On multivariate Cox regression, significant independent predictors of late overall mortality among the entire cohort included age (Hazard Ratio [HR] 1.028), year of diagnosis (HR 0.967), sarcoma (HR 3.36), surgery (HR 0.63) and chemotherapy (HR 0.56).ConclusionPrimary malignant cardiac tumors are rare and associated with poor prognosis. Sarcoma is the most common pathological type. Younger age, recent era diagnosis, surgical resection, and chemotherapy were the independent predictors of better survival. While univariate analysis revealed that patients in the South areas had a worse survival trend compared to other areas, geographic disparity in survival was nullified in multivariate analysis.

Reduced Risk of All-Cause, Cancer-, and Cardiovascular Disease-Related Mortality among Patients with Primary Malignant Cardiac Tumors Receiving Chemotherapy in the United States

“…The results of the current study which used a modern cohort of patients with PMCTs agree with previous studies from SEER as well as other cancer registries that evaluated the role of chemotherapy on survival of patients with PMCTs [ 9 , 14 , 16 , 17 , 20 ]. For instance, the study by Bui et al, which had the same median follow-up of 10 months, like the current study, also reported the same (44%) reduction in all-cause mortality due to chemotherapy use among Black and White patients with PMCT in the United States, regardless of race [ 16 ].…”

“…There is scarcity of data in the modern era on the potential impact of chemotherapy on outcomes in patients with PMCTs. Among the few studies of patients with PMCTs diagnosed in the modern era, results from both the SEER database [ 20 ] and the National Cancer Database [ 14 ] all showed improved survival among patients with PMCTs who received chemotherapy.…”

“…However, most patients present late with PMCTs which makes complete tumor resection either not possible or have variable success [ 14 , 38 , 39 , 40 , 41 , 42 , 43 ]. Chemotherapy is usually indicated for advanced cases of some PMCTs, or as a neoadjuvant therapy before surgery [ 20 , 38 ]. Among patients with primary cardiac lymphoma, chemotherapy is often the preferred primary treatment choice due to the sensitivity of lymphoma to chemotherapy [ 44 ].…”

“…An unintended consequence of studying patients with rare cancers over several decades is the potential for large heterogeneity in treatment regimens influencing the findings [ 19 ]. Furthermore, most prior studies did not adequately consider the potential influence of confounding factors related to treatment selection bias [ 9 , 14 , 16 , 17 , 18 , 20 ]. Also, there is very limited knowledge on the role of chemotherapy on cardiovascular outcomes among patients with PMCTs.…”

Geospatial Patterns of Non-Melanoma Skin Cancer in Relation to Climate Changes in Iran

“…Based on primary epidemiological evidence, solar radiation plays a crucial role in the development of skin cancer. Environmental studies further indicate that the prevalence of this cancer is linked to changes in latitude and altitude [ 9 ]. According to these studies, skin cancer rates tend to increase at lower latitudes and higher altitudes.…”