Cardiovascular mortality by cancer risk stratification in patients with localized prostate cancer: a SEER-based study

Zehao Luo; Kaiyi Chi; Hongjun Zhao; Linglong Liu; Wenting Yang; Zhijuan Luo; Yinglan Liang; Liangjia Zeng; Ruoyun Zhou; Manting Feng; Yemin Li; Guangyao Hua; Huying Rao; Xiaozhen Lin; Min Yi

doi:10.3389/fcvm.2023.1130691

Cardiovascular mortality by cancer risk stratification in patients with localized prostate cancer: a SEER-based study

Front Cardiovasc Med. 2023 Aug 4:10:1130691. doi: 10.3389/fcvm.2023.1130691. eCollection 2023.

Authors

Zehao Luo^{1

2}, Kaiyi Chi^{1

2}, Hongjun Zhao^{2

3}, Linglong Liu^{2

4}, Wenting Yang^{2

5}, Zhijuan Luo^{2

6}, Yinglan Liang^{2

4}, Liangjia Zeng^{2

7}, Ruoyun Zhou^{2

6}, Manting Feng^{1

2}, Yemin Li^{2

8}, Guangyao Hua⁹, Huying Rao¹, Xiaozhen Lin¹⁰, Min Yi¹

Affiliations

¹ Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Cardiovascular Medicine and Cardio-Oncology Group, Medical Exploration and Translation Team, Guangzhou, China.
³ Department of Clinical Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, China.
⁴ Department of Anesthesiology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China.
⁵ Department of Medical Imageology, The Second Clinical College of Guangzhou Medical University, Guangzhou, China.
⁶ Department of Clinical Medicine, The Third Clinical College of Guangzhou Medical University, Guangzhou, China.
⁷ Department of Clinical Medicine, The Nanshan Clinical College of Guangzhou Medical University, Guangzhou, China.
⁸ Department of Clinical Medicine, The First Clinical College of Guangzhou Medical University, Guangzhou, China.
⁹ Department of Cardiology, The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan, China.
¹⁰ Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

Purpose: The risk of cardiovascular disease (CVD) mortality in patients with localized prostate cancer (PCa) by risk stratification remains unclear. The aim of this study was to determine the risk of CVD death in patients with localized PCa by risk stratification.

Patients and methods: Population-based study of 340,806 cases in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with localized PCa between 2004 and 2016. The proportion of deaths identifies the primary cause of death, the competing risk model identifies the interaction between CVD and PCa, and the standardized mortality rate (SMR) quantifies the risk of CVD death in patients with PCa.

Results: CVD-related death was the leading cause of death in patients with localized PCa, and cumulative CVD-related death also surpassed PCa almost as soon as PCa was diagnosed in the low- and intermediate-risk groups. However, in the high-risk group, CVD surpassed PCa approximately 90 months later. Patients with localized PCa have a higher risk of CVD-related death compared to the general population and the risk increases steadily with survival (SMR = 4.8, 95% CI 4.6-5.1 to SMR = 13.6, 95% CI 12.8-14.5).

Conclusions: CVD-related death is a major competing risk in patients with localized PCa, and cumulative CVD mortality increases steadily with survival time and exceeds PCa in all three stratifications (low, intermediate, and high risk). Patients with localized PCa have a higher CVD-related death than the general population. Management of patients with localized PCa requires attention to both the primary cancer and CVD.

Keywords: SEER; cardio-oncology; cardiovascular disease death; prostate cancer; risk stratification.

Grants and funding

This study were funded by the Science and Technology Program of Guangzhou (Grant No. 202102010092), the National Natural Science Foundation of China (Grant No. 82000343), the Special Funds for the Cultivation of Guangdong College Students' Scientific and Technological Innovation. (“Climbing Program” Special Funds) (pdjh2021a0409); the College Students' Innovation Entrepreneurship Training Plan Program of China (Grant Nos. 2021C006 and 2021C005).