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Table 4 Cancer-specific mortality for patients with diagnosis during follow-up, stratified by duration between surgery and diagnosis

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

 

Cancer patientsa(n=2,960)

 

Pumpb

Off pump

Kaplan Meierc

Competing risk modelc

(n=2,388)

(n=572)

 

n

%d

n

%d

HRe

(95% CI)

p-value

HRe

(95% CI)

p-value

Cancers diagnosed within 1 yr of surgery

          

Number of patients with cancer

455

 

126

       

Patients who died from cancer

155

34.1%

41

32.5%

      

• Unadjusted model

    

1.02

(0.72-1.43)

0.932

1.02

(0.72-1.43)

0.932

• Adjusted modelf

    

1.01

(0.72-1.40)

0.969

1.07

(0.82-.1.41)

0.615

• Sensitivity analysis-MCDg

173

38.0%

43

34.1%

      

o Unadjusted model

    

1.08

(0.77-1.52)

0.665

1.08

(0.77-1.52)

0.665

o Adjusted modelf

    

1.11

(0.83-1.45)

0.514

1.19

(0.94-1.51)

0.148

Cancers diagnosed within 2 yrs of surgery

          

Number of patients with cancer

868

 

250

       

Patients who died from cancer

270

31.3%

75

30.0%

      

• Unadjusted model

    

1.00

(0.78-1.28)

0.987

1.00

(0.78-1.28)

0.987

• Adjusted modelf

    

1.05

(0.76-1.47)

0.762

107

(0.79-1.45)

0.656

• Sensitivity analysis-MCDg

299

34.4%

78

31.2%

      

o Unadjusted model

    

1.07

(0.83-1.36)

0.611

1.07

(0.83-1.36)

0.612

o Adjusted modelf

    

1.10

(0.80-1.50)

0.558

1.15

(0.87-1.54)

0.327

Cancers diagnosed within 4 yrs of surgery

          

Number of patients with cancer

1,635

 

448

       

Patients who died from cancer

484

29.6%

123

27.5%

      

• Unadjusted model

    

1.00

(0.79-1.28)

0.980

1.00

(0.80-1.28)

0.980

• Adjusted modelf

    

1.02

(0.79-1.32)

0.868

109

(0.85-1.39)

0.491

• Sensitivity analysis-MCDg

529

32.4%

132

29.5%

      

o Unadjusted model

    

1.02

(0.80-1.29)

0.874

1.02

(0.89-1.29)

0.874

o Adjusted modelf

    

1.05

(0.80-1.38)

0.678

1.10

(0.87-1.40)

0.417

Cancers diagnosed at any time during follow-up

          

• Unadjusted model

668

28.0%

141

24.7%

0.96

(0.78-1.17)

0.665

0.96

(0.78-1.17)

0.665

• Adjusted modelf

    

1.06

(0.85-1.32)

0.595

1.12

(0.89-1.41)

0.330

• Sensitivity analysis-MCDg

          

o Unadjusted model

730

30.6%

154

26.9%

0.96

(0.78-1.16)

0.648

0.96

(0.78-1.16)

0.648

o Adjusted modelf

    

1.04

(0.98-1.09)

0.211

1.11

(0.89-1.39)

0.366

  1. afinal dataset after asymmetric trimming of the propensity score model to improve overlap of the propensity score distributions for patients with and without CPB CABG surgery. The final dataset includes 43,347 patients or 90% of the original dataset.
  2. bincludes patients with ≥1 on-pump procedure prior to incident cancer.
  3. cKaplan-Meier estimate treats failures from competing causes as censored observations; competing risk model with regression of exposure on cause-specific hazard.
  4. d%=number of patients who died / total number in each group*100.
  5. ehazard ratio for pump/off-pump modeled using Cox proportional hazards model with a robust covariance matrix that accounted for survival times for individuals within a hospital. Zero time for analysis was time of the open-heart surgery.
  6. fmodel adjusted age at time of initial cancer diagnosis, gender, race, cancer type, cancer stage, cancer treatment (e.g. chemotherapy, surgery), duration between surgery and cancer diagnosis, use of blood products, year of surgery, and propensity score.
  7. gthe analysis used cancer-specific mortality reported as primary cause of death or underlying cause of death using data from the NCHS multiple cause of death file.
  8. CABG=coronary artery bypass graft, “pump” procedure= CPB=cardiopulmonary bypass.