Dataset Information

Primary site as a novel prognostic factor for cardiovascular mortality post-radiotherapy in limited-stage small cell lung cancer: A large population-based study.

ABSTRACT:

Background

The effect of primary site on cardiovascular mortality (CVM) post-radiotherapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC) remains unclear.

Methods

We screened the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2013. We used cumulative incidence function (CIF) curves to compare CVM incidences, and performed Cox proportional hazards and Fine-Gray competing risk analyses to identify independent risk factors of CVM. Propensity score matching (PSM) analysis was conducted.

Results

Among enrolled 4,824 patients (median age 57 years old, 49.2% were male), CVM accounts for 10.0% of all deaths after 5 years since cancer diagnosis. Hazard ratios (HRs) for CVM were 1.97 (95% CI: 1.23-3.16, P = 0.005) for main bronchus (MB) patients, 1.65 (95% CI: 1.04-2.63, P = 0.034) for lower lobe (LL) patients and 1.01 (95% CI: 0.40-2.59, P = 0.977) for middle lobe (ML) patients compared to upper lobe (UL) patients. CIF curves showed that the cumulative CVM incidence was greater in the re-categorized MB/LL group compared to UL/ML group both before PSM (P = 0.005) and after PSM (P = 0.012). Multivariate regression models indicated that MB/LL was independently associated with an increased CVM risk, before PSM (HR_Cox: 1.79, 95% CI: 1.23-2.61, P = 0.002; HR_Fine-Gray: 1.71, 95% CI: 1.18-2.48, P = 0.005) and after PSM (HR_Cox: 1.88, 95% CI: 1.20-2.95, P = 0.006; HR_Fine-Gray: 1.79, 95% CI: 1.15-2.79, P = 0.010).

Conclusions

MB/LL as the primary site is independently associated with an increased CVM risk post-RT in patients with LS-SCLC.

SUBMITTER: Zhao Y

PROVIDER: S-EPMC9411942 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Primary site as a novel prognostic factor for cardiovascular mortality post-radiotherapy in limited-stage small cell lung cancer: A large population-based study.

Zhao Yuwei Y Qin Fen F Ji Qingqi Q Xia Wuyan W He Ben B

Frontiers in cardiovascular medicine 20220812

<h4>Background</h4>The effect of primary site on cardiovascular mortality (CVM) post-radiotherapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC) remains unclear.<h4>Methods</h4>We screened the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2013. We used cumulative incidence function (CIF) curves to compare CVM incidences, and performed Cox proportional hazards and Fine-Gray competing risk analyses to identify independent risk factors of CVM. Pr ...[more]

PMID: 36035954

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Project description:BackgroundHypofractionated radiotherapy in locally advanced limited-stage small cell lung cancer is preferred in many Western countries but not used regularly in the United States. We examined practice patterns and overall survival with definitive hypofractionated radiotherapy and chemotherapy vs. standard radiotherapy in this setting.MethodsWe included patients in the National Cancer Database with unresected primary stage II-III small cell lung cancer in 2008-2016 who underwent chemotherapy within six months of either hypofractionated radiotherapy (40-45 Gy/15 fractions) or standard radiotherapy (45 Gy/30 fractions or 60-70 Gy/30-35 fractions) in this retrospective cohort study. Patient characteristics were assessed with univariable and multivariable logistic regression. Kaplan-Meier estimator, log-rank test, and multivariable Cox regression were used to evaluate overall survival. Propensity score matching (PSM) was performed as a sensitivity analysis. Early concurrent chemotherapy consisted of radiotherapy and chemotherapy initiated within 30 days of each other.ResultsSeven thousand and one hundred forty-three patients were included: 97.9% received standard radiotherapy and 2.1% hypofractionated radiotherapy. Multivariable analysis on the whole cohort yielded comparable overall survival (HR for hypofractionated radiotherapy 1.09, CI: 0.90-1.32, P=0.37). On PSM (N=292), median overall survival was similar between standard radiotherapy [22.9 months (95% CI: 18.2-30.4 months)] vs. hypofractionated radiotherapy [21.2 months (CI: 16.3-24.7 months); P=0.13]. Overall survival was shorter with hypofractionated radiotherapy in the early concurrent chemotherapy subset (15.8 vs. 22.1 months, P=0.007) and longer with hypofractionated radiotherapy in the non-early concurrent chemotherapy subset (29.5 vs. 18.5 months, P=0.027).ConclusionsOverall survival with hypofractionated radiotherapy appears similar to standard radiotherapy in locally advanced limited-stage small cell lung cancer. Chemotherapy timing may modify the effect of fractionation on overall survival, though larger numbers must confirm. Hypofractionated radiotherapy may be considered in those unable to receive early concurrent chemotherapy.

Dataset Information

Primary site as a novel prognostic factor for cardiovascular mortality post-radiotherapy in limited-stage small cell lung cancer: A large population-based study.

Background

Methods

Results

Conclusions

Publications

Primary site as a novel prognostic factor for cardiovascular mortality post-radiotherapy in limited-stage small cell lung cancer: A large population-based study.

Similar Datasets

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