Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2025
The Risk of Cardiovascular Adverse Outcomes in Patients With Thymoma or Thymic Carcinoma Receiving Cancer Therapy.
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Nardi Agmon Inbar, Zhan Luna Jia, Ho Gloria, Foroutan Farid, Power Coleen, Bezjak Andrea, Keshavjee Shaf, Icht Oded, Miro John, Abdel-Qadir Husam, Hope Andrew, Liu Geoffery, Thavendiranathan Paaladinesh
Аннотация
INTRODUCTION: Thymic neoplasms are often treated with radiation and anthracyclines. Data on cardiovascular events remain limited. The objective of this study is to assess the incidence and predictors of long-term cardiovascular events in patients with thymic neoplasms.
METHODS: This retrospective cohort study included consecutive patients diagnosed with thymic neoplasms between 2004 and 2021. The primary outcome was a composite of the first myocardial infarction, obstructive coronary artery disease (CAD) without infarction, heart failure, atrial fibrillation, stroke, pacemaker implantation, or cardiovascular death. Cancer therapy was modeled as a time-varying covariate. Competing risk models and multivariable extended Cox regression were used.
RESULTS: Among 410 patients (median age 57 y; 50% women) followed for a maximum of 19 years (median 6.9 y), the cumulative incidence of the primary outcome was 11.3% (95% confidence interval [CI] 8.6%-15.0%), 19.5% (15.4%-24.6%), and 28.0% (22.6%-34.8%) at 5, 10, and 14 years of follow-up, respectively. Among the 84 patients with events, some experienced multiple events: heart failure (n = 39), myocardial infarction (n = 20), atrial fibrillation (n = 25), stroke (n = 18), obstructive CAD without infarction (n = 6), pacemaker implantation (n = 6), and cardiovascular death (n = 6). Radiation alone (hazard ratio [HR] 2.9, 95% CI 1.5-5.9, p = 0.003), anthracyclines alone (HR 4.6, 95% CI 1.1-18.8, p = 0.03), and both therapies combined (HR 12.2, 95% CI 4.5-32.7, p < 0.001) were independently associated with increased cardiovascular risk. Baseline cardiovascular comorbidities also increased risk (HR 2.8, 95% CI 1.3-6.2). During follow-up, 94 patients (22.9%) died, most often from recurrent or progressive cancer (56.4%).
CONCLUSIONS: Cardiovascular events are frequent among patients with thymic neoplasms, particularly those treated with radiation and anthracyclines. However, cancer-related mortality remained the predominant cause of death. Long-term cardiovascular surveillance and risk mitigation strategies should be considered.
METHODS: This retrospective cohort study included consecutive patients diagnosed with thymic neoplasms between 2004 and 2021. The primary outcome was a composite of the first myocardial infarction, obstructive coronary artery disease (CAD) without infarction, heart failure, atrial fibrillation, stroke, pacemaker implantation, or cardiovascular death. Cancer therapy was modeled as a time-varying covariate. Competing risk models and multivariable extended Cox regression were used.
RESULTS: Among 410 patients (median age 57 y; 50% women) followed for a maximum of 19 years (median 6.9 y), the cumulative incidence of the primary outcome was 11.3% (95% confidence interval [CI] 8.6%-15.0%), 19.5% (15.4%-24.6%), and 28.0% (22.6%-34.8%) at 5, 10, and 14 years of follow-up, respectively. Among the 84 patients with events, some experienced multiple events: heart failure (n = 39), myocardial infarction (n = 20), atrial fibrillation (n = 25), stroke (n = 18), obstructive CAD without infarction (n = 6), pacemaker implantation (n = 6), and cardiovascular death (n = 6). Radiation alone (hazard ratio [HR] 2.9, 95% CI 1.5-5.9, p = 0.003), anthracyclines alone (HR 4.6, 95% CI 1.1-18.8, p = 0.03), and both therapies combined (HR 12.2, 95% CI 4.5-32.7, p < 0.001) were independently associated with increased cardiovascular risk. Baseline cardiovascular comorbidities also increased risk (HR 2.8, 95% CI 1.3-6.2). During follow-up, 94 patients (22.9%) died, most often from recurrent or progressive cancer (56.4%).
CONCLUSIONS: Cardiovascular events are frequent among patients with thymic neoplasms, particularly those treated with radiation and anthracyclines. However, cancer-related mortality remained the predominant cause of death. Long-term cardiovascular surveillance and risk mitigation strategies should be considered.