Skip to main content

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.