Risk of cardiac-related death in astrocytoma patients treated with chemotherapy: A competing risk analysis using the SEER database

Xuezhen Wang; Xiaoxia Li; Yufan Wu; Jinsheng Hong; Dajun Chai; Mingwei Zhang

doi:10.3389/fcvm.2023.996354

Risk of cardiac-related death in astrocytoma patients treated with chemotherapy: A competing risk analysis using the SEER database

Front Cardiovasc Med. 2023 Apr 25:10:996354. doi: 10.3389/fcvm.2023.996354. eCollection 2023.

Authors

Xuezhen Wang^{1

2}, Xiaoxia Li^{1

2}, Yufan Wu^{1

2}, Jinsheng Hong^{1

2

3}, Dajun Chai^{2

4}, Mingwei Zhang^{1

2

3}

Affiliations

¹ Department of Radiotherapy, Cancer Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
² National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁴ Cardiovascular Department, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.

Abstract

Purpose: To explore the impact of chemotherapy on the risk of cardiac-related death in astrocytoma patients.

Methods: 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.

Results: 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, P = 0.002) and after PSM (HR = 0.550, 95%CI: 0.367-0.823 P = 0.004). Sensitivity analysis determined that the E-value of chemotherapy was 2.848 and 3.038 before and after PSM.

Conclusions: 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.

Keywords: PSM; cardiac-related death; chemotherapy; competing risk analysis; glioma.