Increased risk of non-hematological cancer in young patients with aortic stenosis: a retrospective cohort study.
Age
Aortic stenosis
Cancer
Risk
Journal
Cardio-oncology (London, England)
ISSN: 2057-3804
Titre abrégé: Cardiooncology
Pays: England
ID NLM: 101689938
Informations de publication
Date de publication:
25 Oct 2021
25 Oct 2021
Historique:
received:
19
07
2021
accepted:
13
10
2021
entrez:
26
10
2021
pubmed:
27
10
2021
medline:
27
10
2021
Statut:
epublish
Résumé
We have previously reported an increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis (AS). These findings were the result of a post-hoc analysis from a large echocardiography database and needed verification. Our aim was to determine, using a different study population, whether young patients with AS are at increased risk for cancer. A large echocardiographic database was used to identify patients (age ≥ 20 years) with moderate or severe AS (study group) and patients without aortic stenosis (comparative group). The new occurrence of non-hematological malignancies was determined after the index date (first echo with moderate or severe AS or first recorded echo in the control group). The final study group included 7013 patients with AS and 98,884 without AS. During a median follow-up of 6.9 years (3.0-11.1) there were 10,705 new cases of non-hematological cancer. The crude incidence rate of cancer was higher in AS compared to non-AS patients (22.3 vs. 13.7 per 1000 patient-year, crude HR 1.58 (95%CI 1.46-1.71). After adjustment for relevant covariates, there was no difference between groups (HR 0.93, 95% CI 0.86-1.01). Only patients in the lowest age quartile (20-49.7 years), had an increased adjusted risk of cancer (HR 1.91, 95%CI 1.08-3.39). The HR for the risk of cancer associated with AS was inversely proportional to age (P < 0.001 for the interaction between AS and age). Young patients with moderate or severe AS may have an increased risk for cancer. Cancer surveillance should be considered for young patients with AS.
Sections du résumé
BACKGROUND
BACKGROUND
We have previously reported an increased risk for non-hematological malignancies in young patients with moderate or severe aortic stenosis (AS). These findings were the result of a post-hoc analysis from a large echocardiography database and needed verification. Our aim was to determine, using a different study population, whether young patients with AS are at increased risk for cancer.
METHODS
METHODS
A large echocardiographic database was used to identify patients (age ≥ 20 years) with moderate or severe AS (study group) and patients without aortic stenosis (comparative group). The new occurrence of non-hematological malignancies was determined after the index date (first echo with moderate or severe AS or first recorded echo in the control group).
RESULTS
RESULTS
The final study group included 7013 patients with AS and 98,884 without AS. During a median follow-up of 6.9 years (3.0-11.1) there were 10,705 new cases of non-hematological cancer. The crude incidence rate of cancer was higher in AS compared to non-AS patients (22.3 vs. 13.7 per 1000 patient-year, crude HR 1.58 (95%CI 1.46-1.71). After adjustment for relevant covariates, there was no difference between groups (HR 0.93, 95% CI 0.86-1.01). Only patients in the lowest age quartile (20-49.7 years), had an increased adjusted risk of cancer (HR 1.91, 95%CI 1.08-3.39). The HR for the risk of cancer associated with AS was inversely proportional to age (P < 0.001 for the interaction between AS and age).
CONCLUSIONS
CONCLUSIONS
Young patients with moderate or severe AS may have an increased risk for cancer. Cancer surveillance should be considered for young patients with AS.
Identifiants
pubmed: 34696798
doi: 10.1186/s40959-021-00123-w
pii: 10.1186/s40959-021-00123-w
pmc: PMC8547104
doi:
Types de publication
Journal Article
Langues
eng
Pagination
37Informations de copyright
© 2021. The Author(s).
Références
Circulation. 2020 Aug 18;142(7):684-687
pubmed: 32804565
Circulation. 2020 Aug 18;142(7):670-683
pubmed: 32475164
Stat Med. 1999 Mar 30;18(6):695-706
pubmed: 10204198
Am J Prev Med. 2014 Mar;46(3 Suppl 1):S7-15
pubmed: 24512933
J Am Coll Cardiol. 2000 Oct;36(4):1152-8
pubmed: 11028464
J Am Coll Cardiol. 2021 Feb 23;77(7):875-884
pubmed: 33602470
J Am Coll Cardiol. 2016 Jul 19;68(3):265-271
pubmed: 27417004
J Am Coll Cardiol. 2009 Nov 10;54(20):1862-8
pubmed: 19892237
Circulation. 1994 Aug;90(2):844-53
pubmed: 7519131
J Am Soc Echocardiogr. 2017 Apr;30(4):372-392
pubmed: 28385280
J Am Coll Cardiol. 2013 Sep 3;62(10):881-6
pubmed: 23810869
Annu Rev Physiol. 2013;75:685-705
pubmed: 23140366
Cell Mol Life Sci. 2009 Jul;66(14):2219-30
pubmed: 19308325
J Am Heart Assoc. 2020 Jan 21;9(2):e013754
pubmed: 31960736
Isr Med Assoc J. 2021 Jan;23(1):23-27
pubmed: 33443338
Nat Med. 2020 Sep;26(9):1452-1458
pubmed: 32661390
Nat Med. 2020 Jan;26(1):71-76
pubmed: 31932807
Circulation. 2018 Aug 14;138(7):678-691
pubmed: 29459363
Cardiovasc Res. 2019 Apr 15;115(5):844-853
pubmed: 30715247
Anat Rec A Discov Mol Cell Evol Biol. 2005 Dec;287(2):1205-12
pubmed: 16240445
N Engl J Med. 2021 Apr 15;384(15):1412-1423
pubmed: 33626250
Eur J Heart Fail. 2016 Mar;18(3):260-6
pubmed: 26751260
Circulation. 2005 Feb 22;111(7):920-5
pubmed: 15710758
J Am Soc Echocardiogr. 2019 Jan;32(1):1-64
pubmed: 30282592
Heart. 2013 Mar;99(6):396-400
pubmed: 22942293
Lancet. 2006 Sep 16;368(9540):1005-11
pubmed: 16980116