Zhao Qiang, Zhou Qiaohong, Dong Jiayue, Tong Qiang
Department of Cardiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
Front Cardiovasc Med. 2025 Apr 22;12:1459151. doi: 10.3389/fcvm.2025.1459151. eCollection 2025.
The increasing prevalence of cardiovascular mortality is becoming a significant worry for individuals who have survived cancer. The aim of this study is to investigate the dynamic trend of cardiovascular death in patients with gastric cancer (GC) and identify the risk factors associated with cardiovascular disease (CVD)-specific mortality in non-metastatic GC patients.
In the present study, 29,324 eligible patients diagnosed with primary GC were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios (SMRs) adjusted by age, gender, calendar year, and race were calculated. Fine-Gray's competing risk models were taken to identify the prognostic factors of cardiovascular death in GC patients.
There were 1083 (5.2%) cardiovascular deaths among 20,857 patients with local/regional GC, and 76 (0.9%) cardiovascular deaths among 8,467 patients with metastatic GC. The SMRs of CVD-specific mortality continuously increased since the 1975s throughout the 2015s. The competing risk models showed that age (>75 years vs. 0-50 years, HR: 6.602, 95% CI: 4.356-10.006), T stage (T4 vs. T1, HR:0.524, 95% CI: 0.370-0.741), N stage (N3 vs. N0, HR: 0.557, 95% CI: 0.343-0.903), surgery (Yes vs. No, HR: 0.551, 95% CI: 0.461-0.659), and radiotherapy (Yes vs. No, HR: 1.011, 95% CI: 1.011-1.437) were predictive of CVD-specific mortality. Furthermore, based on the results of the competing risk analyses, a nomogram was constructed to predict the probability of CVD-specific mortality for local/regional GC patients.
Our study demonstrated the dynamic trend of cardiovascular death in GC patients, and identified prognostic risk predictors, highlighting the importance cardio-oncology teams in offering comprehensive care and long-term follow-up for GC patients.
心血管疾病死亡率的不断上升正成为癌症幸存者的一大担忧。本研究旨在调查胃癌（GC）患者心血管死亡的动态趋势，并确定非转移性GC患者心血管疾病（CVD）特异性死亡的相关危险因素。
在本研究中，从监测、流行病学和最终结果（SEER）数据库收集了29324例诊断为原发性GC的合格患者。计算了按年龄、性别、日历年份和种族调整的标准化死亡率（SMR）。采用Fine-Gray竞争风险模型确定GC患者心血管死亡的预后因素。
20857例局部/区域GC患者中有1083例（5.2%）发生心血管死亡，8467例转移性GC患者中有76例（0.9%）发生心血管死亡。自20世纪70年代至2015年代，CVD特异性死亡率的SMR持续上升。竞争风险模型显示，年龄（>75岁vs.0-50岁，HR：6.602，95%CI：4.356-10.006）、T分期（T4 vs.T1，HR：0.524，95%CI：0.370-0.741）、N分期（N3 vs.N0，HR：0.557，95%CI：0.343-0.903）、手术（是vs.否，HR：0.551，95%CI：0.461-0.659）和放疗（是vs.否，HR：1.011，95%CI：1.011-1.437）可预测CVD特异性死亡。此外，基于竞争风险分析结果，构建了一个列线图来预测局部/区域GC患者CVD特异性死亡的概率。
我们的研究展示了GC患者心血管死亡的动态趋势，并确定了预后风险预测因素，凸显了心脏肿瘤学团队为GC患者提供全面护理和长期随访的重要性。
