Effects of radical cystectomy, radiotherapy, and chemotherapy on the risk of long-term heart-specific death in bladder cancer patients

Fuhan Yang; Cheng Li; Yadong Guo; Yang Yu; Shiyu Mao; Ruiliang Wang; Wentao Zhang; Aihong Zhang; Xudong Yao

doi:10.21037/tau-21-835

Effects of radical cystectomy, radiotherapy, and chemotherapy on the risk of long-term heart-specific death in bladder cancer patients

Transl Androl Urol. 2021 Oct;10(10):3826-3836. doi: 10.21037/tau-21-835.

Authors

Fuhan Yang^#^{1

2}, Cheng Li^#^{1

2}, Yadong Guo^#^{1

2}, Yang Yu^{1

2}, Shiyu Mao^{1

2}, Ruiliang Wang^{1

2}, Wentao Zhang^{1

2}, Aihong Zhang³, Xudong Yao^{1

2}

Affiliations

¹ Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
² Institute of Urologic Oncology, School of Medicine, Tongji University, Shanghai, China.
³ Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Background: At present, the low risk of bladder cancer (BCa)-specific death has allowed for investigation into treatment-related cardiotoxicity. To aid clinicians in selecting appropriate cardiovascular disease screening strategies and interventions, this study explored the heart-specific mortality and prognostic factors of patients with BCa after radical cystectomy (RC), radiotherapy (RT), or chemotherapy (CT), and compared their long-term heart-specific mortality with that of the general male population.

Methods: We identified three different treatments for BCa patients from the Surveillance, Epidemiology, and End Results (SEER) database: RC, RT, and CT. Patients were included from 2000 to 2012 and followed through 2015. A cumulative mortality curve and competitive risk regression model were applied to evaluate the prognostic factors of heart-specific mortality, and standardized mortality ratios (SMRs) were calculated.

Results: Of 39,500 men, 30.3%, 18.8%, and 50.9% received RC, RT, and CT, respectively. For patients with a survival period of less than 50 months, tumor-specific death exhibited a rapidly increasing trend, which subsequently flatlined. However, the rates heart-specific mortality and other causes exhibited a tendency to increase stably. The heart-specific and all-cause mortality rates of patients in any age group treated with the three abovementioned strategies were higher than those of the general population. The heart-specific mortality of patients with carcinoma in situ treated with RC and CT exceeded their all-cause mortality, while that of other tumor stages did not. The risks of heart-specific [sub-distribution hazard ratio (SHR) =1.38; 95% confidence interval (CI): 1.22-1.57] and tumor-specific (SHR =1.68; 95% CI: 1.60-1.77) deaths in patients who received RT were higher than those of patients who underwent CT.

Conclusions: The risks of heart-specific and tumor-specific deaths in patients who received RT were higher than those of the RC and CT groups, especially in patients over 65 years of age who received RT.

Keywords: Bladder cancer (BCa); Surveillance, Epidemiology, and End Results (SEER); cardiovascular disease; competing risk.