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

BMC Cancer

Kitaw Demissie¹  John B Kostis²  Bart Holland⁴  David A August³  Stephen Marcella⁵  Cathy Anne Pinto⁵ 

[1]The Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, NJ, USA

[2]Cardiovascular Institute, Rutgers-Robert Wood Johnson Medical School for the MIDAS Study Group, New Brunswick, NJ, USA

[3]Division of Surgery Oncology, Department of Surgery, The Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, NJ, USA

[4]Department of Preventive Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA

[5]Department of Epidemiology, Rutgers, Piscataway, NJ, USA

关键词: Population-based cohort study;    Cancer progression;    Cardiopulmonary bypass;   

Others  :  1079475
DOI  :  10.1186/1471-2407-13-519

 received in 2013-03-22, accepted in 2013-10-09,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Pinto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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