Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment
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D. Herrero Rivera [1] ; J. M. Nieto-Guerrero Gómez [1] ; J. Cacicedo Fernández de Bobadilla [2] ; D. Delgado [1] ; E. Rivin del Campo [3] ; J. M. Praena-Fernández [1] ; R. Bernabé Caro [1] ; M. J. Ortiz Gordillo [1] ; M. C. Fernández Fernández [1] ; J. L. Lopez Guerra [1]
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[1] Hospital Universitario Virgen del Rocío
Hospital Universitario Virgen del Rocío
Sevilla, España
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[2] Instituto de Investigación Sanitaria Biocruces Bizkaia
Instituto de Investigación Sanitaria Biocruces Bizkaia
Barakaldo, España
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[3] Tenon University Hospital, Francia
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- Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 9 (September), 2019, págs. 1220-1230
- Idioma: inglés
- Texto completo no disponible (Saber más ...)
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Resumen
Purpose Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC).
Materials and methods Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3–60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12–70]); and 50 (15%) patients underwent surgery.
Results Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31–88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025).
Conclusions HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.
