Risk of mortality and other adverse outcomes from myocardial infarction in cancer survivors: a meta-analysis.

BACKGROUND AND PURPOSE: Myocardial infarction (MI) is an acute cardiovascular disease that can increase prognosis risks such as arrhythmia, heart failure, shock, etc. Studies have found that even well-controlled coexistence of cancer could affect the quality of life in MI patients. However, the prognostic impact of cancer on MI patients is controversial. This meta-analysis aimed to assess the influence of cancer on the risk of future all-cause mortality, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) in MI patients. METHODS: The Embase, PubMed, and Cochrane libraries were searched for cohort studies and case-control from inception to May 2022. The quality of the included pieces of literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analyses were performed using Stata statistical software versions 14.0 and 16.0. Sensitivity analysis assessed the robustness of the results, and funnel plots and Egger's tests evaluated the publication bias. RESULTS: A total of 10 studies were included, covering 7,210,530 participants. Summary analyses show that compared with non-cancer patients, cancer increased the risk of long-term all-cause mortality in MI patients (HR 1.58, 95% CI 1.36-1.84, I2 = 94.2%). However, no significant difference was observed in the risk of cardiovascular mortality (HR 1.18, 95% CI 0.91-1.54, I2 = 52.4%) or MACCE (HR 1.26, 95% CI 0.94-1.70, I2 = 99.2%). In subgroup analysis, cancer was associated with the risk of recurrent MI (HR 1.18, 95% CI 1.03-1.34, I2 = 88.8%), and major bleeding (HR 2.01, 95% CI 1.60-2.52, I2 = 93.1%), with no significant difference in the risk of stroke (HR 1.11, 95% CI 0.97-1.27, I2 = 85.1%). CONCLUSION: This meta-analysis shows that cancer increases the risk of all-cause mortality, recurrent MI, and major bleeding in MI patients but is not associated with the risk of cardiovascular death. Therefore, comprehensive multidisciplinary management and monitoring of potential future adverse events in MI patients with cancer are needed. SYSTEMATIC REVIEW REGISTRATION: The meta-analysis was registered in the International Register of Prospective Systematic Reviews (NO. CRD42022332775).

Tumor pathological response and downstaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: comparison of two radiation dose schedules / 中华放射医学与防护杂志

Objective To assess the short-term efficacy and tolerability of different radiotherapy doses schedules as 46 Gy and 50 Gy for locally advanced rectal cancer patients undergoing neoadjuvant chemoradiotherapy.Methods All patients with locally advanced rectal cancer who had received neoadjuvant chemoradiotherapy between Aug 2010 and May 2015 were enrolled.This retrospective analysis was performed according to the radiotherapy dose grouping of 46 Gy and 50 Gy groups.Concurrent chemotherapy regimen was capecitabine-based and oxaliplatin was added only when young patients (＜ 75 years old) were in a good condition.Total mesorector excision was scheduled 6-8 weeks after concurrent chemoradiotherapy.Results Totally 213 patients were enrolled in our analysis,including 61 cases in 46 Gy group and 152 cases in 50 Gy group.There were 145 male and 68 female patients.There were 22 patients diagnosed clinically with T2,180 with T3,and 11 with T4.Tumor distance from the anal verge was ≤5,＞5 and ＜ 10 cm,or ≥10 cm in 82,115 and 16 patients,respectively.T downstaging was observed in 95 (44.6％) patients,pathologic complete response (PCR) was shown in 48 (22.5％) patients.In the 46 Gy and 50 Gy groups,the rate of PCR was 18.0％ vs.24.3％ (P ＞0.05).In addition,good response rate (TRG 3 + 4) was 67.2％ vs.75.0％ (P ＞ 0.05),and T downstaging rate was 39.3％ vs.46.7％ (P ＞0.05).Subgroup analysis for T3N2/T4 patients,the rate of PCR was 6.3％ vs.23.3％ (P＞0.05),good response rate (TRG 3 +4) was 50.0％ vs.72.1％ (P＞0.05),and T downstaging was 31.3％ vs.46.5％ (P ＞0.05).There was no significant difference in treatment-related toxicity between the two groups.Conclusions The two different radiation dose fractionation (50 Gy vs.46 Gy) had no impact on pathologic tumor regression and T downstaging for locally advanced rectal cancer.Nonetheless,a further long-term follow-up is warranted to confirm the preliminary study.