Key result
Main bronchus or lower lobe primary tumor site was independently associated with an increased risk of cardiovascular mortality (HR 1.88) post-radiotherapy in patients with limited-stage small cell lung cancer compared to upper or middle lobe sites.
Why the study?
The effect of primary tumor site on cardiovascular mortality following radiotherapy in patients with limited-stage small cell lung cancer remained unclear.
Does primary tumor site in the main bronchus or lower lobe increase cardiovascular mortality in patients with limited-stage small cell lung cancer post-radiotherapy?
Cohort (n=4,824)
Does primary tumor site in the main bronchus or lower lobe increase cardiovascular mortality in patients with limited-stage small cell lung cancer post-radiotherapy?
In patients with limited-stage small cell lung cancer receiving radiotherapy, having a primary tumor in the main bronchus or lower lobe is independently associated with a significantly increased risk of cardiovascular mortality compared to upper or middle lobe tumors.
Answers are grounded in this paper and cite their sources.
May identify higher-risk patients for cardiac monitoring post-radiotherapy in limited-stage SCLC; hypothesis-generating and requires prospective validation.
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.
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Zhao et al. (2022) conducted a cohort in Limited-stage small cell lung cancer (LS-SCLC) (n=4,824). Main bronchus or lower lobe (MB/LL) primary tumor site vs. Upper lobe or middle lobe (UL/ML) primary tumor site was evaluated on Cardiovascular mortality (CVM) (HR 1.88, 95% CI 1.20-2.95, p=0.006). Main bronchus or lower lobe primary tumor site was independently associated with an increased risk of cardiovascular mortality (HR 1.88) post-radiotherapy in patients with limited-stage small cell lung cancer compared to upper or middle lobe sites.
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