Cardiovascular and cerebrovascular related death among patients with esophageal cancer: an international multicenter study.

Background: Esophageal cancer (EC) has high incidence and mortality. Non-cancer deaths, particularly from cardiovascular and cerebrovascular related death (CCD), are increasing. The aim of this study is to investigate the risk factors associated with CCD in patients diagnosed with EC. Methods: The data of patients diagnosed with EC was retrospectively extracted from the Surveillance, Epidemiology, and End Results (SEER) database, the cause of death and follow-up information were collected. Mortality was calculated by cumulative incidence function (CIF), and the competing risk regression was utilized for risk factor analysis. In addition, cases of EC with in-hospital death in a Chinese hospital were collected, the cause of death and risk factors of CCD were analyzed. Results: The study included a total of 24,291 patients from SEER cohort and 133 patients from Chinese hospital cohort. During the follow-up period of SEER cohort, 21,272 (87.6%) patients succumbed to mortality, 931 (3.8%) of them were CCD, while 20,341 (83.7%) died from other causes. The median overall survival time was found to be 10 months [interquartile range (IQR), 4-28 months], age, sex, race, surgery, and tumor stage as independent risk factors for CCD. In the Chinese cohort, 133 patients with EC died in hospital, of which 25 (18.8%) were CCD, logistic regression showed that smoking history, history of hypertension, history of heart disease and high total cholesterol were independent risk factors for CCD. Conclusions: CCD is the primary cause among all non-cancer deaths in patients with EC, which seriously affects the expected survival of patients and should be prevented by risk factors.