Key result
Radiotherapy was associated with a higher risk of heart-specific death compared to chemotherapy in men with bladder cancer (SHR 1.38; 95% CI 1.22-1.57).
Why the study?
The low risk of bladder cancer-specific death has allowed investigation into treatment-related cardiotoxicity, prompting evaluation of heart-specific mortality after radical cystectomy, radiotherapy, or chemotherapy compared with the general population.
Does the type of bladder cancer treatment (RC, RT, or CT) affect the risk of long-term heart-specific death compared to each other and the general population?
Cohort (n=39,500)
Yes
Does the type of bladder cancer treatment (RC, RT, or CT) affect the risk of long-term heart-specific death compared to each other and the general population?
Radiotherapy for bladder cancer is associated with a higher risk of long-term heart-specific mortality compared to chemotherapy or radical cystectomy, highlighting the need for cardiovascular screening in this population.
May warrant cardiac surveillance after radiotherapy for bladder cancer; leaves open causality versus selection bias pending prospective validation.
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.
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Yang et al. (2021) conducted a cohort in Bladder cancer (n=39,500). Radiotherapy vs. Chemotherapy was evaluated on Heart-specific mortality (SHR 1.38, 95% CI 1.22-1.57). Radiotherapy was associated with a higher risk of heart-specific death compared to chemotherapy in men with bladder cancer (SHR 1.38; 95% CI 1.22-1.57).
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