Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis

Our plain-English summary of Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis, by M. Rahouma, S. Khairallah, A. Dabsha, et al (Frontiers in Oncology, 2023).

The study

• Authors: M. Rahouma, S. Khairallah, A. Dabsha, M. Baudo, M.M. El-Sayed Ahmed, I. Gambardella, C. Lau, Y.M. Esmail, A. Mohamed, L. Girardi, M. Gaudino, R. Lorusso, S.L. Mick
• Journal: Frontiers in Oncology
• Published: 2023;13:1071770
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Primary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies. Geographic survival disparities have not been reported previously for PMCT and the aim of this study is to compare the prevalence and the long-term survival rate with respect to the geographic location of PMCTs using the Surveillance, Epidemiology, and End Results (SEER) research plus data 17 registries between 2000 and 2019.

Methods: The SEER database was queried to identify geographic variation among PMCTs. We classified the included states into 4 geographical regions (Midwest, Northeast, South and West regions) based on the U.S. Census Bureau-designated regions and divisions. Different demographic and clinical variables were analyzed and compared between the four groups. Kaplan Meier curves and Cox regression were used for survival assessment.

Results: A total of 563 patients were included in our analysis. The median age was 53 years (inter-quartile range (IQR): 38 - 68 years) and included 26, 90, 101, and 346 patients from the Midwest, Northeast, South, and West regions respectively. Sarcoma represented 65.6% of the cases, followed by hematological tumors (26.2%), while mesothelioma accounted for 2.1%. Treatment analysis showed no significant differences between different regions. Median overall survival was 11, 21, 13, and 11 months for Midwest, Northeast, South and West regions respectively and 5-year overall survival was 22.2%, 25.4%, 14.9%, and 17.6% respectively. On multivariate Cox regression, significant independent predictors of late overall mortality among the entire cohort included age (Hazard Ratio [HR] 1.028), year of diagnosis (HR 0.967), sarcoma (HR 3.36), surgery (HR 0.63) and chemotherapy (HR 0.56).

Conclusion: Primary malignant cardiac tumors are rare and associated with poor prognosis. Sarcoma is the most common pathological type. Younger age, recent era diagnosis, surgical resection, and chemotherapy were the independent predictors of better survival. While univariate analysis revealed that patients in the South areas had a worse survival trend compared to other areas, geographic disparity in survival was nullified in multivariate analysis.

Copyright © 2023 Rahouma, Khairallah, Dabsha, Baudo, El-Sayed Ahmed, Gambardella, Lau, Esmail, Mohamed, Girardi, Gaudino, Lorusso and Mick.

In plain English

This study analyzed U.S. cancer registry data (SEER, 2000 to 2019) on primary malignant cardiac tumors, which are cancers that start in the heart. After exclusions, 563 patients were included: 26 from the Midwest, 90 from the Northeast, 101 from the South and 346 from the West. Sarcoma made up 65.6% of cases, hematological tumors 26.2% and mesothelioma 2.1% (12 patients). The study did not collect or analyze asbestos exposure. Treatment did not differ significantly between regions. Five-year overall survival was 22.2% in the Midwest, 25.4% in the Northeast, 14.9% in the South and 17.6% in the West. This difference was not statistically significant (log rank P=0.24). In a simple analysis, the South showed a trend toward higher mortality than the Northeast (HR 1.39, 95% CI 0.99 to 1.93). No region differed significantly once other factors were taken into account. Older age, earlier year of diagnosis and sarcoma were linked to higher mortality. Surgery and chemotherapy were linked to lower mortality. The authors noted that the registry lacked comorbidity and insurance data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a U.S. population-based cancer registry (SEER research plus data 17 registries), with Kaplan-Meier survival curves and Cox regression
• Who was studied: 563 patients with a single primary malignant cardiac tumor diagnosed 2000 to 2019 in SEER registries (from 714 cases; 27 excluded for missing survival time, 124 for more than one malignancy). By region: 26 Midwest, 90 Northeast, 101 South, 346 West
• Exposure: Geographic region (Midwest, Northeast, South, West, using U.S. Census Bureau regions). Asbestos or any other fiber exposure was not studied.
• Main results:
  • Among all 563 patients, sarcoma was the most common tumor type (65.6%), followed by hematological tumors (26.2%), while mesothelioma accounted for 2.1%
  • Mesothelioma: 12 patients (2.1%) overall, with 1 in the Midwest, 3 in the Northeast, 0 in the South and 8 in the West (p=0.356 for regional difference)
  • 292 patients (51.9%) had surgery, 307 (54.5%) chemotherapy and 65 (11.5%) radiotherapy. Treatment did not differ significantly between regions.
  • Median overall survival was 11 months (95% CI 7 to 47) in the Midwest, 21 (12 to 41) in the Northeast, 13 (8 to 17) in the South and 11 (9 to 16) in the West
  • 5-year overall survival was 22.2% (Midwest), 25.4% (Northeast), 14.9% (South) and 17.6% (West); overall log rank P=0.24
  • In univariate Cox regression, the South region showed a trend toward higher late mortality than the Northeast (HR 1.39, 95% CI 0.99 to 1.93, P=0.054)
  • In multivariable analysis, no geographic region showed a significant difference in long-term survival
  • Multivariable predictors of late overall mortality in the whole cohort: age (HR 1.028, 95% CI 1.013 to 1.043) and year of diagnosis (HR 0.967, 95% CI 0.946 to 0.988)
  • Multivariable predictors in the whole cohort also included sarcoma versus hematological tumor (HR 3.36, 95% CI 2.40 to 4.69), surgery (HR 0.63, 95% CI 0.48 to 0.81) and chemotherapy (HR 0.56, 95% CI 0.44 to 0.71)
  • Overall, 78.2% of patients had died by the end of follow-up; median survival was 10 months
• The authors' conclusion: The authors concluded that primary malignant cardiac tumors are rare, carry a poor prognosis and are most often sarcomas. Younger age, more recent diagnosis, surgical resection and chemotherapy were independent predictors of better survival. The South's worse survival trend in univariate analysis was not seen in multivariate analysis.
• Limitations the authors state:
  • Prevalence may be underestimated because SEER records only cases diagnosed in living patients, not postmortem diagnoses, and these tumors can present as sudden cardiac death
  • Patients may move between regions over time, which could affect the geographic analysis
  • SEER did not report comorbidities, genetic details or individual risk factors
  • The SEER version used had no data on insurance, education level or type of healthcare facility
  • Treatment details such as doses and side effects of chemotherapy or radiotherapy were not reported, so their effect on survival could not be assessed

Topics

Medical terms in this study, explained in our Lexicon: SEER, Epidemiology, Sarcoma, Mesothelioma, Median Overall Survival, Overall Survival, Hazard Ratio, Chemotherapy.

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