Effect of cardiovascular risk factors on overall survival in postoperative patients with esophageal squamous cell carcinoma: a retrospective cohort analysis.

Background: Cardiovascular disease (CVD) and esophageal squamous cell carcinoma (ESCC) may share common risk factors. This study aimed to explore the association between modifiable cardiovascular risk factors (CVRFs) and prognosis in ESCC patients after radical surgery, as well as their impact on survival outcomes. Methods: A retrospective analysis was conducted on 497 postoperative patients with stage II-III ESCC from Fujian Provincial Hospital. Modifiable CVRFs, including hypertension, diabetes, dyslipidemia, high body mass index (BMI), and smoking, were evaluated for their impact on overall survival (OS). Patients were categorized into low-CVRF and high-CVRF groups based on the number of combined CVRF, followed by a 60-month follow-up. Kaplan-Meier (K-M) was used to survival analysis, and least absolute shrinkage and selection operator (LASSO) logistic regression was performed for prognosis-related variable selection. Finally, Cox proportional hazard regression was performed to assess survival associations, with adjustment for confounding factors. Results: After adjusting for confounders, diabetes [hazard ratio (HR) =1.96; 95% confidence interval (CI): 1.41-2.72; P<0.001] and hypertension (HR =1.28; 95% CI: 0.96-1.72; P=0.09) were associated with worse OS, among which diabetes was an independent risk factor. The high-CVRF group had worse OS (HR =1.54; 95% CI: 1.14-2.08; P=0.005), and for each additional CVRF, the risk of adverse OS increased significantly (HR =1.15; 95% CI: 1.02-1.31; P=0.02). Subgroup analysis showed that the negative impact of high-CVRFs on OS was more significant in the chemoradiotherapy subgroups: the chemotherapy subgroup (HR =2.62; 95% CI: 1.71-4.01; P<0.001) and the radiotherapy subgroup (HR =2.01; 95% CI: 1.19-3.40; P=0.009). Diabetic patients had poorer prognosis in the chemotherapy subgroup (HR =3.72; 95% CI: 2.24-6.18; P<0.001) and the radiotherapy subgroup (HR =3.08; 95% CI: 1.65-5.75; P<0.001). Conclusions: Diabetes is an independent risk factor for worse OS in patients with stage II-III ESCC after radical surgery. The cumulative burden of CVRFs (especially high-CVRFs) is associated with an increased risk of postoperative mortality, and this association is more prominent in patients receiving chemotherapy or radiotherapy. These findings suggest that individualized cardiovascular risk monitoring and treatment strategies should be developed in clinical practice for ESCC patients with comorbid CVRFs.