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. 2013 Nov 3:13:519.
doi: 10.1186/1471-2407-13-519.

Cardiopulmonary bypass has a modest association with cancer progression: a retrospective cohort study

Cathy Anne Pinto  1 , Stephen Marcella, David A August, Bart Holland, John B Kostis, Kitaw Demissie
Affiliations

Cardiopulmonary bypass has a modest association with cancer progression: a retrospective cohort study

Cathy Anne Pinto et al. BMC Cancer. .

Abstract

Background: Given their frequency of occurrence in the United States, cancer and heart disease often coexist. For patients requiring open-heart surgery, this raises concern that the use of cardiopulmonary bypass (CPB) may cause a transient immunosuppression with the potential to promote the spread and growth of coexisting cancer cells. This study examined the association of cardiopulmonary bypass with cancer progression in a large population-based setting using linked data from several state-wide registries.

Methods: A retrospective cohort study of cancer risk, stage, and mortality in 43,347 patients who underwent coronary artery bypass graft (CABG) surgery with and without CPB in New Jersey between 1998-2004 was conducted. A competing risk analogue of the Cox proportional hazards model with propensity score adjustment and regression on the cause-specific hazard was used to compute relative risk ratios (95% confidence intervals [CIs]) for patients undergoing CABG surgery with and without CPB.

Results: An increased risk for overall cancer incidence (17%) and cancer-specific mortality (16% overall, 12% case fatality) was observed; yet these results did not reach statistical significance. Of 11 tumor-specific analyses, an increased risk of skin melanoma (1.66 [95% CI, 1.08-2.55: p=0.02]) and lung cancer (1.36 [95% CI, 1.02-1.81: p=0.03]) was observed for patients with pump versus off-pump open-heart surgery. No association was found with cancer stage.

Conclusions: These results suggest that there may be a relationship between CPB and cancer progression. However, if real, the effect is likely modest at most. Further research may still be warranted with particular focus on skin melanoma and lung cancer which had the strongest association with CPB.

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Figures

Figure 1
Figure 1
Boxplot of propensity scores by exposure status and quantiles of propensity score distribution. Legend. Final analytical dataset including a total of 43,347 coronary artery bypass patients. 1 and 0 designates patients with pump and off-pump exposure status, respectively.
Figure 2
Figure 2
Kaplan Meier survival curve for cancer-specific mortality for patients with open-heart surgery and cancer diagnosed during follow-up, by CPB status Legend: Includes 2,960 cancer patients in study cohort.
See this image and copyright information in PMC

References

    1. Sablotzki A, Welters I, Lehmann N, Menges T, Gorlach G. et al.Plasma levels of immunoinhibitory cytokine interleukin-10 and transforming growth factor-β in patients undergoing coronary artery bypass grafting. Eur J Cardio Thorac Surg. 1997;11(4):763–768. doi: 10.1016/S1010-7940(97)01154-8. - DOI - PubMed
    1. Markewitz A, Lante W, Franke A, Marohl K, Kuhlmann WD, Weinhold C. Alterations of cell mediated immunity following cardiac operations: clinical implications and open questions. Shock. 2001;16(Suppl 1):10–15. - PubMed
    1. Viera RD, Pereira AC, Lima EG, Garzillo CL, Rezende PC. et al.Cancer-related deaths among different treatment options in chronic coronary artery disease: results of a 6-year follow-up of the MASS II study. Coronary Artery Diesase. 2012;23:79–84. doi: 10.1097/MCA.0b013e32834f112a. - DOI - PubMed
    1. Mistiaen W, Van Cauwelaert P, Muylaert P, Wuyts F, Harrisson F, Bortier H. Effect of prior malignancy on survival after cardiac surgery. Ann Thorac Surg. 2004;77:1593–1597. doi: 10.1016/j.athoracsur.2003.08.049. - DOI - PubMed
    1. Carrascal Y, Gualis J, Arevalo A, Fulquet E, Florez S, Rey J. Cardiac surgery with extracorporeal circulation in cancer patients: influence on surgical morbidity and mortality on survival. Rev Esp Cardiol. 2008;61(4):369–375. doi: 10.1157/13117728. - DOI - PubMed