Abstract
Background: The aim of this study was to assess the role of cardiac and vascular parameters as all-cause mortality determinants in patients suffering from gynecological cancers. Methods: This was an observational, prospective, non-randomized, and non-controlled study. Forty-seven consecutive patients (mean age: 58 ± 13 years) were enrolled after cancer staging. All patients underwent evaluation of vascular (common carotid intima-media thickness (mean C-IMT), flow-mediated dilation of the brachial artery (FMD), and antero-posterior diameter of the infrarenal abdominal aorta (APAO)) and cardiac function and morphology before cancer-related interventions. A 6-year follow-up was carried out to assess the overall survival of the whole population. Results: Twenty patients (42%) died by the time of the 6-year follow-up. The brachial artery FMD values were higher in the survivors than the non-survivors (9.71 ± 3.53% vs. 6.13 ± 2.62%, p < 0.001), as well as the LVEF (60.8 ± 3.0% vs. 57.8 ± 4.4%, p = 0.009). There were no differences in the mean C-IMT, APAO, and other echocardiographic parameters. ROC curve analysis identified a baseline LVEF < 57% and FMD value < 5.8% as the best cut-offs. Kaplan–Meier evaluation showed that the LVEF, tricuspid annular plane systolic excursion, and FMD were the best predictors of all-cause mortality, although only the LVEF and FMD were confirmed in multivariate Cox regression analysis. Conclusions: The LVEF and brachial artery FMD are independent prognostic determinants in patients with gynecological cancers.
Highlights
The values of the brachial artery flow-mediated vasodilatation (FMD) were better in the survivors than the non-survivors (9.71 ± 3.53% vs. 6.13 ± 2.62%, p < 0.001), while no differences were found in terms of the mean C-IMT and antero-posterior diameter of the infrarenal abdominal aorta (APAO) values between the groups (p = 0.48 and p = 0.45, respectively)
The present study demonstrated that baseline evaluation of the cardiac and vascular parameters might improve the evaluation of the prognoses of women suffering from major gynecological cancers
We demonstrated that an left ventricle ejection fraction (LVEF) ≤ 57% was able to detect patients’ mortality with a sensibility of 50%, specificity of 88.9%, and area under the curve (AUC) of 0.740
Summary
Detection and advances in chemotherapy and targeted therapy have improved the prognoses of many types of cancer in terms of reduction in the mortality rate and an increase in the life expectancy [3,4]. The adoption of dedicated chemotherapeutical protocols combined with improvement in surgical therapy can improve the overall survival of patients suffering from gynecological cancers [5,6,7]. Anti-tumor drugs may be associated with significant cardiovascular toxicity. About 30% of patients treated with chemotherapy develop abnormal heart functioning, which is classified as “relevant” in 15% and “serious” (risk of fatal heart failure) in 1% of cases [8]. Cardiovascular toxicity worsens the prognoses of these patients and limits the choice of the chemotherapeutical regimen, the dose intensity, and the potential anti-tumor efficacy of the therapy
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