The Risk of Heart Disease-Related Death Among Anaplastic Astrocytoma Patients After Chemotherapy: A SEER Population-Based Analysis

Qi Lin; Jia-Hao Bao; Fei Xue; Jia-Jun Qin; Zhen Chen; Zhong-Rong Chen; Chao Li; Yi-Xuan Yan; Jin Fu; Zhao-Li Shen; Xian-Zhen Chen

doi:10.3389/fonc.2022.870843

The Risk of Heart Disease-Related Death Among Anaplastic Astrocytoma Patients After Chemotherapy: A SEER Population-Based Analysis

Front Oncol. 2022 Jun 20:12:870843. doi: 10.3389/fonc.2022.870843. eCollection 2022.

Authors

Qi Lin¹, Jia-Hao Bao², Fei Xue¹, Jia-Jun Qin¹, Zhen Chen¹, Zhong-Rong Chen¹, Chao Li¹, Yi-Xuan Yan², Jin Fu¹, Zhao-Li Shen¹, Xian-Zhen Chen¹

Affiliations

¹ Department of Neurosurgery, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
² Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.

Abstract

Background: 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.

Methods: 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.

Results: 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, P<0.001). For competing risk regression analysis, the cumulative incidence of HDRD in non-chemotherapy exceeded HDRD in the chemotherapy group (P<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, P=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, P=0.11). Landmark analysis showed that AA patients who received chemotherapy had better heart disease-specific survival than those in the non-chemotherapy group (P=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.

Conclusion: 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.

Keywords: SEER; anaplastic astrocytoma; cardio-oncology; chemotherapy; heart disease-related death.