Cardiovascular Mortality in Patients with Gynecological Cancers: A Population-based Cohort Study

ObjectiveThe survival rate of gynecological cancers (GCs) has improved significantly in recent decades. Patients with GCs did not necessarily succumb to the primary cancer. Cardiovascular health might be a critical determinant of long-term survival. This study aimed to investigate the mortality rate and risk factors associated with cardiovascular disease (CVD) death in patients with GCs. MethodsA total of 399,399 cases of GCs diagnosed between 2000 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. The standardized mortality ratio (SMR) for CVD mortality was estimated. Prognostic factors for CVD death were assessed using cause-specific hazard ratios with 95% confidence intervals within a competing risk model, considering non-cardiovascular death as a competing risk. ResultsOf the 399,399 patients with GCs, 117,551 (29%) died from GCs, and 16,371 (4.1%) died from CVD. Of the CVD deaths, 73.2% were attributed to heart disease. The SMR of CVD mortality was highest in survivors diagnosed before age 45 years, and the risk of CVD mortality remained elevated throughout the follow-up period compared to the general United States (US) population. In recent years, the SMRs for CVD mortality risk increased steadily in all subtypes of GCs, except for vulvar cancer. Older age, black race, localized stage, unmarried/single/divorced, vaginal and vulvar cancers, and radiation therapy were associated with a higher risk of CVD mortality. A nomogram was developed and validated using these variables to predict CVD death risk in patients with GCs. ConclusionsThe risk of CVD mortality in patients with GCs was increased and was significantly higher compared with the general US population. A nomogram was constructed and validated to forecast the risk of CVD mortality in individuals with GCs. More attention should be paid to cardiovascular health during diagnosis to improve survival rates. HIGHLIGHTS{Rightarrow} 29% of patients with gynecological cancers died from cancer, while 4.1% died from CVD, with 73.2% of CVD deaths attributed to heart disease. {Rightarrow}In recent years, SMRs for CVD mortality increased steadily across all GC subtypes, except vulvar cancer. {Rightarrow}Higher CVD mortality was linked to older age, black race, localized disease stage, unmarried/single/divorced status, and prior radiation therapy, especially in vaginal and vulvar cancers. {Rightarrow}We developed and validated a nomogram to predict CVD death risk in GC patients, aiding personalized patient management.