Cardiovascular risk factors and outcomes in patients with thymoma receiving cancer therapy
Notice bibliographique
Résumé
Abstract Background There is limited data on cardiovascular disease (CVD) in patients diagnosed with thymoma. In this retrospective study we sought to assess prevalent and incident CVD in patients diagnosed with thymoma. Methods Using our thymoma registry, 410 patients diagnosed with thymoma between January 1, 2004 to December 31, 2020 were included. Clinical data collected through electronic medical records included: demographics, cancer treatment, CVD risk factors, and prevalent CVD. Incident CVD was collected until August 31, 2024. Our primary outcome was MACE consisting of a new diagnosis of coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), stroke, pacemaker implantation and cardiovascular (CV) death. Cumulative incidence of MACE was estimated using the Gray subdistribution method with non-CV death as a competing risk. Results Amongst the 410 patients (median age 57 years (Q1-Q3 46-67), 50% female), hypertension was the most prevalent baseline CV risk factor (n=121 [29.5%]). Previous CVD history included CAD in 16 (3.9%), HF in 5 (1.2%), AF in 15 (3.7%) and stroke in 5 (1.2%) patients. Ninety-nine (24%) patients had baseline echocardiogram. Treatment for first diagnosis of thymoma included surgery in 366 (89%) patients. Mediastinal radiation was given in 199 (48%) patients, at a median dose of 46 Gy (IQR 40-50 Gy). Chemotherapy was used in 107 (26%) patients, of whom 37 (9%) received anthracyclines. Recurrent/ongoing disease was documented in 116 (28%) patients; 25 (22%) of whom subsequently received mediastinal radiation and 22 (19%) received anthracyclines. Only 146 (36%) patients had an echocardiogram during follow-up period. Over a median follow-up time of 6.8 years (IQR 4.5-11.1), death occurred in 94 (33%) patients, of whom 6 (6.4%) were attributed to CVD. Thirty-nine (9.5%) patients developed HF, 26 (6%) had obstructive CAD, 25 (6.1%) with AF, and 6 (1.5%) patients had pacemaker implantation. The cumulative incidence of MACE over the follow-up period was 40.4% (95% CI: 30.2-53.9%]) (Figure 1). Patients who experienced MACE were older at thymoma diagnosis (61 vs. 56 years, p=0.03) and were more likely to be male (59% vs. 47%, p=0.05), compared to those without. There were no significant differences in the prevalence of baseline smoking, HTN, DM, CAD, HF, AF and stroke. Greater proportion of patients with MACE received mediastinal radiation (80% vs. 44%, p<0.001) and/or anthracyclines (21% vs. 12%, p=0.031). The hazard ratio (HR) for MACE was 2.5 (95% CI 1.39-4.47, p=0.002) with mediastinal radiation alone, and 8.6 (4.24-17.83, p<0.001) when both radiation and anthracyclines were used. Conclusion Approximately 1 in 5 patients developed CV events after diagnosis of thymoma. Use of mediastinal radiation with or without anthracyclines increase the risk. Despite these risks, cardiovascular monitoring was limited. There is a need to establish CV risk assessment and surveillance, in patients diagnosed with thymoma.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».