Abstract
BACKGROUND: Tumor characteristics are associated with the risk of cardiovascular death (CVD) in cancer patients. However, the influence of tumor characteristics on CVD risk among prostate cancer (PC) patients who have received radiotherapy (RT) or chemotherapy (CT) is often overlooked. This study explored the association between PC tumor characteristics and CVD risk in PC patients who had received RT or CT. METHODS: Fine-gray competitive risk analysis was employed to identify CVD risk factors. Sensitivity analyses were conducted to adjust for confounding factors. The predicted prostate-specific antigen (PSA) and Gleason score values were visualized using a nomogram, which was subsequently validated through calibration curves and concordance indexes (C-indexes). RESULTS: A total of 120,908 patients were enrolled in the study, with a mean follow-up time of 80 months. PSA values between 10 and 20 ng/mL (adjusted hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.20-1.36, p < 0.001) and >20 ng/mL (adjusted HR: 1.27, 95% CI: 1.21-1.35, p < 0.001), and a Gleason score >7 (adjusted HR: 1.23, 95% CI: 1.07-1.41, p = 0.004) were identified as risk factors of CVD for PC patients after RT or CT. The C-index of the training cohort was 0.66 (95% CI: 0.66-0.67), and the C-index of the validation cohort was 0.67 (95% CI: 0.65-0.68). Consistency was observed between the actual observations and the nomogram. Risk stratification was also significant (p < 0.001). CONCLUSIONS: PSA values ≥10 ng/mL and Gleason scores >7 may be associated with an increased risk of CVD in PC patients after RT or CT. These patients may require more long-term follow-up and monitoring of CVD risk.