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

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

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.870843

DOI=10.3389/fonc.2022.870843

ISSN=2234-943X

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 risk of heart disease-related death 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 HDRD risk. Based on competing risk model, we calculated cumulative incidences of HDRD and non-HDRD and performed univariate and multivariate regression analysis. 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 months and 314 months was employed to minimize immortal time bias
Results: AA patients with chemotherapy were at lower HDRD risk compared those patients with no 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 chemotherapy group (P<0.001) and multivariable analysis showed lower HDRD risk in AA patients with chemotherapy (Adjusted SHR=0.574, 95%CI=0.331-0.991, P=0.046). In PSM-after cohort, there were no significant association between chemotherapy and increased HDRD risk (Adjusted SHR=0.595, 95%CI=0.316−1.122, P=0.11). Landmark analysis showed AA patients received chemotherapy had better heart disease-specific survival than those in non-chemotherapy group (P=0.007) at follow-up time points of 216 months. No difference was found when follow-up time was more than 216 months.
Conclusion: AA patients with chemotherapy are associated with lower risk of HDRD compared with those without chemotherapy. Our findings may help clinicians make 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.