A Study Of Cardiovascular Disease Mortality Risk In Patients With Ovarian Malignancy In The United State

Background:Advances in medicine have led to advances in cancer prevention,diagnosis,and treatment,and the population of cancer survivors is steadily increasing.As cancer survival rates improve,non-cancer events,especially cardiovascular disease(CVD),have become an important cause of death in cancer patients.Studies show that about 1 in 10 cancer patients die not from cancer,but from CVD.With the improvement of the 5-year survival rate of patients with ovarian malignant tumors,especially in developed countries,CVD deaths have also attracted more and more attention.While developing the field of treatment,timely identification and control of non-cancer mortality factors is an important way to reduce all-cause mortality and improve quality of life in patients with ovarian malignant tumors,which will help us better predict those who may be most at risk for screening,and provide reference for making corresponding survival plans.However,the current study does not describe the risk of death from CVD in patients with ovarian malignancy,so this study will use large sample data for further analysis.Objectives:The objectives of this study were as follows:(1)analyze the mortality risk of CVD in patients with ovarian malignancy compared to the general population;(2)screening patients with ovarian malignant tumors with a high risk of CVD death and risk factors;(3)determine whether chemotherapy increases the risk of death from CVD in patients with ovarian malignancies.Methods:We identified retrospective cohorts from the National Cancer Institute’s(NCI)Surveillance,Epidemiology,and End Results(SEER)database for patients diagnosed with primary ovarian malignancy from January 1,1973 to December 31,2016.Available data on demographic characteristics are extracted from it: age at diagnosis,ethnicity,year of diagnosis,marital status at diagnosis,place of residence,insured status and socio-economic indicators(income and educational status).Information on tumor-related features,including histologic subtype,differentiation grade,clinical stage,and treatment information(surgery,radiotherapy and chemotherapy)was collected.At the same time,we also extracted follow-up time and cause of death data for patients with ovarian malignant tumors,used mortality data collected by the National Center for Health Statistics(NCHS)for the general population,and used the Poisson regression model(PRM)to assess Standardized mortality rate(SMR).The COX proportional hazards regression model was constructed to perform univariate and multivariate analysis and plotted the cumulative mortality curve to determine the risk factors associated with the higher risk of CVD death in patients with ovarian malignant tumors,and the difference was statistically significant in P<0.05(bilateral).Results:Among the 149204 patients with ovarian malignancy observed in 768,840 person-years,6,517 patients with CVD deaths were identified,with a mortality rate of 847.64/100,000.The SMR of CVD in patients with ovarian malignancy was 2.08(95% CI: 2.03–2.14),indicating that patients with ovarian malignancy had a significantly higher risk of CVD death than the general population.A higher relative risk of CVD death was observed in patients with malignant germ cell tumors(SMR = 2.94;95% CI: 2.31–3.73)and ovarian epithelial carcinoma type I(SMR = 2.20;95% CI: 2.10 –2.30),second only to other types of ovarian malignancies.In patients diagnosed at age 20 to 24 years(SMR = 11.78;95% CI: 5.62–24.71)and25 to 29(SMR = 11.73;95% CI: 7.07– 19.45),CVD had the highest SMR in all age subgroups,and gradually decreased in patients diagnosed at age >34 years of ovarian malignancy.For survivors of ovarian malignancy of all subtypes,SMR for CVD was relatively high 0 to 1 year after diagnosis(SMR = 2.31;95% CI: 2.20–2.42)and highest ten years after diagnosis(SMR = 4.93;95% CI: 4.73–5.41),showing a decreasing and then rising trend.However,this risk remained elevated throughout the follow-up period compared to the general population.Univariate and multivariate analyses using the COX proportional hazards regression model yielded older age at diagnosis of ovarian malignancy [HR = 1.10;95% CI: 1.09–1.10;P < 0.001],black(HR =1.51;95% CI: 1.38– 1.65;P < 0.001),unmarried(HR = 1.14;95% CI: 1.08 – 1.20;P < 0.001),low education(HR = 1.12;95% CI: 1.02–1.23;P < 0.016),and low income(HR = 1.19;95% CI: 1.09–1.30;P<0.001)was associated with an increased risk of CVD death.In addition,in clinical staging,patients with ovarian malignancy with regional(HR = 1.20;95% CI:1.10–1.31;P<0.001)and distant(HR = 1.26;95% CI:1.17–1.35;P<0.001)had an increased risk of death from CVD compared with localized patients.Receiving radiation therapy(compared with no radiation therapy;HR = 0.84;95% CI: 0.75–0.94;P =0.002),chemotherapy(compared with no chemotherapy;HR=0.67;95% CI: 0.64–0.71;P < 0.001)and surgery(HR<1;P < 0.001)were associated with a lower risk of CVD death compared with no surgery.In subgroup analysis,almost all subtypes of patients with ovarian malignancies benefited from chemotherapy.Conclusion:The risk of death from CVD in patients with ovarian malignancy is significantly higher than in the general population,and is mainly different in patients with different age of diagnosis,time after diagnosis,and patients with different histological subtypes.Our findings suggest that older age,unmarried status,low educational attainment,and low income at diagnosis are associated with a significantly increased chance of dying from CVD.In addition,patients with intermediate and advanced ovarian malignancies are at increased risk of dying from CVD in clinical staging.Chemotherapy reduces the risk of death from CVD in patients with ovarian malignancies,which may be related to the fact that chemotherapy reduces the cardiovascular burden of ovarian malignancies themselves.