Lin Qi, Bao Jia-Hao, Xue Fei, Qin Jia-Jun, Chen Zhen, Chen Zhong-Rong, Li Chao, Yan Yi-Xuan, Fu Jin, Shen Zhao-Li, Chen Xian-Zhen
Department of Neurosurgery, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
Front Oncol. 2022 Jun 20;12:870843. doi: 10.3389/fonc.2022.870843. eCollection 2022.
Despite improved overall survival outcomes, chemotherapy has brought concerns for heart disease-related death (HDRD) among cancer patients. The effect of chemotherapy on the risk of HDRD in anaplastic astrocytoma (AA) patients remains unclear.
We obtained 7,129 AA patients from the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2016. Kaplan-Meier and Cox regression analysis were conducted to evaluate the effect of chemotherapy on the HDRD risk. Based on the competing risk model, we calculated the cumulative incidences of HDRD and non-HDRD and performed univariate and multivariate regression analyses. Then, a 1:1 propensity score matching (PSM) was used to improve the comparability between AA patients with and without chemotherapy. Landmark analysis at 216 and 314 months was employed to minimize immortal time bias.
AA patients with chemotherapy were at a lower HDRD risk compared to those patients without chemotherapy (adjusted HR=0.782, 95%CI=0.736-0.83, <0.001). For competing risk regression analysis, the cumulative incidence of HDRD in non-chemotherapy exceeded HDRD in the chemotherapy group (<0.001) and multivariable analysis showed a lower HDRD risk in AA patients with chemotherapy (adjusted SHR=0.574, 95%CI=0.331-0.991, =0.046). In the PSM-after cohort, there were no significant association between chemotherapy and the increased HDRD risk (adjusted SHR=0.595, 95%CI=0.316-1.122, =0.11). Landmark analysis showed that AA patients who received chemotherapy had better heart disease-specific survival than those in the non-chemotherapy group (=0.007) at the follow-up time points of 216 months. No difference was found when the follow-up time was more than 216 months.
AA patients with chemotherapy are associated with a lower risk of HDRD compared with those without chemotherapy. Our findings may help clinicians make a decision about the management of AA patients and provide new and important evidence for applying chemotherapy in AA patients as the first-line treatment. However, more research is needed to confirm these findings and investigate the correlation of the risk of HDRD with different chemotherapy drugs and doses.
尽管总体生存结果有所改善，但化疗引发了癌症患者中心脏病相关死亡（HDRD）的担忧。化疗对间变性星形细胞瘤（AA）患者发生HDRD风险的影响仍不清楚。
我们从1975年至2016年的监测、流行病学和最终结果（SEER）数据库中获取了7129例AA患者。进行了Kaplan-Meier和Cox回归分析，以评估化疗对HDRD风险的影响。基于竞争风险模型，我们计算了HDRD和非HDRD的累积发生率，并进行了单变量和多变量回归分析。然后，采用1:1倾向评分匹配（PSM）来提高接受化疗和未接受化疗的AA患者之间的可比性。采用216个月和314个月时的标志性分析，以尽量减少不朽时间偏倚。
与未接受化疗的患者相比，接受化疗的AA患者发生HDRD的风险较低（调整后HR = 0.782，95%CI = 0.736 - 0.83，<0.001）。对于竞争风险回归分析，非化疗组中HDRD的累积发生率超过化疗组（<0.001），多变量分析显示接受化疗的AA患者发生HDRD的风险较低（调整后SHR = 0.574，95%CI = 0.331 - 0.991，= 0.046）。在倾向评分匹配后的队列中，化疗与HDRD风险增加之间无显著关联（调整后SHR = 0.595，95%CI = 0.316 - 1.122，= 0.11）。标志性分析显示，在216个月的随访时间点，接受化疗的AA患者的心脏病特异性生存率高于非化疗组（= 0.007）。随访时间超过216个月时未发现差异。
与未接受化疗的患者相比，接受化疗的AA患者发生HDRD的风险较低。我们的研究结果可能有助于临床医生对AA患者的管理做出决策，并为将化疗作为AA患者的一线治疗提供新的重要证据。然而，需要更多的研究来证实这些发现，并研究HDRD风险与不同化疗药物和剂量之间的相关性。
