Wang Xuezhen, Li Xiaoxia, Wu Yufan, Hong Jinsheng, Chai Dajun, Zhang Mingwei
Department of Radiotherapy, Cancer Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Front Cardiovasc Med. 2023 Apr 25;10:996354. doi: 10.3389/fcvm.2023.996354. eCollection 2023.
To explore the impact of chemotherapy on the risk of cardiac-related death in astrocytoma patients.
We retrospectively evaluated astrocytoma patients diagnosed between 1,975 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. Using Cox proportional hazards models, we compared the risks of cardiac-related death between a chemotherapy group and non-chemotherapy group. Competing-risks regression analyses were used to evaluate the difference in cardiac-related death. Also, propensity score matching (PSM) was employed to reduce confounding bias. The robustness of these findings was evaluated by sensitivity analysis, and E values were calculated.
A total of 14,834 patients diagnosed with astrocytoma were included. Chemotherapy (HR = 0.625, 95%CI: 0.444-0.881) was associated with cardiac-related death in univariate Cox regression analysis. Chemotherapy was an independent prognostic factor for a lower risk of cardiac-related death before (HR = 0.579, 95%CI: 0.409-0.82, = 0.002) and after PSM (HR = 0.550, 95%CI: 0.367-0.823 = 0.004). Sensitivity analysis determined that the E-value of chemotherapy was 2.848 and 3.038 before and after PSM.
Chemotherapy did not increase the risk of cardiac-related death in astrocytoma patients. This study highlights that cardio-oncology teams should provide comprehensive care and long-term monitoring for cancer patients, especially those with an increased risk of cardiovascular disease.
探讨化疗对星形细胞瘤患者心脏相关死亡风险的影响。
我们回顾性评估了监测、流行病学和最终结果（SEER）数据库中1975年至2016年间诊断的星形细胞瘤患者。使用Cox比例风险模型，我们比较了化疗组和非化疗组之间心脏相关死亡的风险。采用竞争风险回归分析来评估心脏相关死亡的差异。此外，采用倾向评分匹配（PSM）来减少混杂偏倚。通过敏感性分析评估这些发现的稳健性，并计算E值。
共纳入14834例诊断为星形细胞瘤的患者。在单变量Cox回归分析中，化疗（HR = 0.625，95%CI：0.444 - 0.881）与心脏相关死亡相关。化疗是心脏相关死亡风险较低的独立预后因素，在PSM之前（HR = 0.579，95%CI：0.409 - 0.82，P = 0.002）和之后（HR = 0.550，95%CI：0.367 - 0.823，P = 0.004）。敏感性分析确定化疗在PSM之前和之后的E值分别为2.848和3.038。
化疗不会增加星形细胞瘤患者心脏相关死亡的风险。本研究强调心脏肿瘤学团队应为癌症患者，尤其是心血管疾病风险增加的患者提供全面护理和长期监测。
