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Clinical impact of perioperative atrial fibrillation on long-term recurrence of malignancy

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Abstract

Perioperative complications have been reported to be associated with a lower incidence of cancer-free survival. Perioperative atrial fibrillation (POAF) is one of occasionally observed complications in patients with malignancies who undergo noncardiac surgeries. However, the long-term clinical impact of POAF on those with malignancies have remained unknown. This was a prospective, single-center, observational study. Patients who underwent noncardiac surgeries for definitive malignancies between 2014 and 2017 were included. The primary and secondary endpoints were 3-year recurrence of malignancies and cancer death, respectively. The present study included consecutive 752 patients (mean age, 68 ± 11 years; males, 62%), and POAF was observed in 77 patients. The follow-up duration was 1037 (interquartile range, 699–1408) days. The 3-year recurrence of malignancies was observed in 239 (32%) patients (POAF, 32 [42%]; non-POAF, 207 [31%]) and 3-year mortality was 130 patients (17%). Cardiac, noncardiac, and cancer deaths were observed in 4 (0.5%), 126 (17%), and 111 (15%) patients, respectively. Multivariate Cox regression analysis demonstrated that POAF was associated with 3-year recurrence of malignancies (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.15–2.52). Landmark analysis demonstrated that POAF tended to be correlated with the incidence of 3-year cancer death (HR, 1.79; 95% CI, 0.96–3.31). In conclusion, POAF is associated with the subsequent recurrence of malignancies. The association of arrhythmia with cancer death may be revealed under longer follow-up durations.

Clinical Trial Registration: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000018270. UMIN ID: UMIN000016146.

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References

  1. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  2. Mokart D, Giaoui E, Barbier L, Lambert J, Sannini A, Chow-Chine L, Brun JP, Faucher M, Guiramand J, Ewald J, Bisbal M, Blache JL, Delpero JR, Leone M, Turrini O (2016) Postoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality. J Crit Care 31(1):48–53

    Article  Google Scholar 

  3. Wang S, Xu L, Wang Q, Li J, Bai B, Li Z, Wu X, Yu P, Li X, Yin J (2019) Postoperative complications and prognosis after radical gastrectomy for gastric cancer: a systematic review and meta-analysis of observational studies. World J Surg Oncol 17(1):52

    Article  Google Scholar 

  4. Higuchi S, Kabeya Y, Matsushita K, Arai N, Tachibana K, Tanaka R, Kawachi R, Takei H, Suzuki Y, Kogure M, Imanishi Y, Moriyama K, Yorozu T, Saito K, Abe N, Sugiyama M, Kondo H, Yoshino H (2019) Incidence and complications of perioperative atrial fibrillation after non-cardiac surgery for malignancy. PLoS ONE 14(5):e0216239

    Article  Google Scholar 

  5. Friberg L, Rosenqvist M, Lip GY (2012) Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. Circulation 125(19):2298–2307

    Article  CAS  Google Scholar 

  6. Andersson T, Magnuson A, Bryngelsson IL, Frøbert O, Henriksson KM, Edvardsson N, Poçi D (2013) All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J 34(14):1061–1067

    Article  Google Scholar 

  7. Jurin I, Lucijanic M, Jurin H, Starcevic B, Varvodic J, Catic J, Jurisic A, Vitlov P, Sokol Tomic S, Lucijanic J, Hadzibegovic I (2020) Patients with atrial fibrillation and mid-range ejection fraction differ in anticoagulation pattern, thrombotic and mortality risk independently of CHA(2)DS(2)-VAS(C) score. Heart Vessels 35(9):1243–1249

    Article  Google Scholar 

  8. Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS, Kamel H (2014) Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA 312(6):616–622

    Article  CAS  Google Scholar 

  9. Butt JH, Olesen JB, Havers-Borgersen E, Gundlund A, Andersson C, Gislason GH, Torp-Pedersen C, Kober L, Fosbol EL (2018) Risk of thromboembolism associated with atrial fibrillation following noncardiac surgery. J Am Coll Cardiol 72(17):2027–2036

    Article  Google Scholar 

  10. Higuchi S, Kabeya Y, Matsushita K, Arai N, Tachibana K, Tanaka R, Kawachi R, Takei H, Suzuki Y, Kogure M, Imanishi Y, Moriyama K, Sugiyama M, Yorozu T, Saito K, Abe N, Kondo H, Yoshino H (2019) Perioperative atrial fibrillation in noncardiac surgeries for malignancies and one-year recurrence. Can J Cardiol 35(11):1449–1456

    Article  Google Scholar 

  11. Aguilar M, Nattel S (2019) Postoperative atrial fibrillation after noncardiac surgery: maybe not so benign after all. Can J Cardiol 35(11):1423–1425

    Article  Google Scholar 

  12. Vinter N, Christesen AMS, Fenger-Grøn M, Tjønneland A, Frost L (2018) Atrial fibrillation and risk of cancer: a Danish population-based cohort study. J Am Heart Assoc 7(17):e009543

    Article  Google Scholar 

  13. Kamp DW, Shacter E, Weitzman SA (2011) Chronic inflammation and cancer: the role of the mitochondria. Oncology (Williston Park) 25(5):400–410

    Google Scholar 

  14. Wu R, Fang J, Liu M, Jun A, Liu J, Chen W, Li J, Ma G, Zhang Z, Zhang B, Fu L, Dong JT (2020) SUMOylation of the transcription factor ZFHX3 at Lys-2806 requires SAE1, UBC9, and PIAS2 and enhances its stability and function in cell proliferation. J Biol Chem 295(19):6741–6753

    Article  CAS  Google Scholar 

  15. Conen D, Wong JA, Sandhu RK, Cook NR, Lee IM, Buring JE, Albert CM (2016) Risk of malignant cancer among women with new-onset atrial fibrillation. JAMA Cardiol 1(4):389–396

    Article  Google Scholar 

  16. Hung YP, Hu YW, Liu CJ, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Liao JN, Chung FP, Chen TJ, Chen SA, Albert CM, Chao TF (2019) Risk and predictors of subsequent cancers of patients with newly-diagnosed atrial fibrillation—a nationwide population-based study. Int J Cardiol 296:81–86

    Article  Google Scholar 

  17. Higuchi S, Kabeya Y, Matsushita K, Tachibana K, Kawachi R, Takei H, Suzuki Y, Abe N, Imanishi Y, Moriyama K, Yorozu T, Saito K, Sugiyama M, Kondo H, Yoshino H (2018) The study protocol for PREDICT AF RECURRENCE: a PRospEctive cohort stuDy of surveIllanCe for perioperaTive Atrial Fibrillation RECURRENCE in major non-cardiac surgery for malignancy. BMC Cardiovasc Disord 18(1):127

    Article  Google Scholar 

  18. Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M (2013) Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 20(5):1575–1583

    Article  Google Scholar 

  19. Climent M, Hidalgo N, Vidal Ó, Puig S, Iglesias M, Cuatrecasas M, Ramón JM, García-Albéniz X, Grande L, Pera M (2016) Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer. Eur J Surg Oncol 42(1):132–139

    Article  CAS  Google Scholar 

  20. Watanabe M, Kinoshita T, Tokunaga M, Kaito A, Sugita S (2018) Complications and their correlation with prognosis in patients undergoing total gastrectomy with splenectomy for treatment of proximal advanced gastric cancer. Eur J Surg Oncol 44(8):1181–1185

    Article  Google Scholar 

  21. Ostenfeld EB, Erichsen R, Pedersen L, Farkas DK, Weiss NS, Sørensen HT (2014) Atrial fibrillation as a marker of occult cancer. PLoS ONE 9(8):e102861

    Article  Google Scholar 

  22. Rudolph V, Andrié RP, Rudolph TK, Friedrichs K, Klinke A, Hirsch-Hoffmann B, Schwoerer AP, Lau D, Fu X, Klingel K, Sydow K, Didié M, Seniuk A, von Leitner EC, Szoecs K, Schrickel JW, Treede H, Wenzel U, Lewalter T, Nickenig G, Zimmermann WH, Meinertz T, Böger RH, Reichenspurner H, Freeman BA, Eschenhagen T, Ehmke H, Hazen SL, Willems S, Baldus S (2010) Myeloperoxidase acts as a profibrotic mediator of atrial fibrillation. Nat Med 16(4):470–474

    Article  CAS  Google Scholar 

  23. Chandel NS, Tuveson DA (2014) The promise and perils of antioxidants for cancer patients. N Engl J Med 371(2):177–178

    Article  CAS  Google Scholar 

  24. Zhang YL, Cao HJ, Han X, Teng F, Chen C, Yang J, Yan X, Li PB, Liu Y, Xia YL, Guo SB, Li HH (2020) Chemokine receptor CXCR-2 initiates atrial fibrillation by triggering monocyte mobilization in mice. Hypertension 76(2):381–392

    Article  Google Scholar 

  25. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ (2014) Age and cancer risk: a potentially modifiable relationship. Am J Prev Med 46(3 Suppl 1):S7-15

    Article  Google Scholar 

  26. Friberg L, Benson L, Rosenqvist M, Lip GY (2012) Assessment of female sex as a risk factor in atrial fibrillation in Sweden: nationwide retrospective cohort study. BMJ 344:e3522

    Article  Google Scholar 

  27. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, Whincup PH, Mukamal KJ, Gillum RF, Holme I, Njølstad I, Fletcher A, Nilsson P, Lewington S, Collins R, Gudnason V, Thompson SG, Sattar N, Selvin E, Hu FB, Danesh J (2011) Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 364(9):829–841

    Article  Google Scholar 

  28. Maixent JM, Paganelli F, Scaglione J, Lévy S (1998) Antibodies against myosin in sera of patients with idiopathic paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 9(6):612–617

    Article  CAS  Google Scholar 

  29. Su VY, Hu YW, Chou KT, Ou SM, Lee YC, Lin EY, Chen TJ, Tzeng CH, Liu CJ (2013) Amiodarone and the risk of cancer: a nationwide population-based study. Cancer 119(9):1699–1705

    Article  CAS  Google Scholar 

  30. Andersson P, Frigyesi A (2019) High-sensitivity troponin T is an important independent predictor in addition to the Simplified Acute Physiology Score for short-term ICU mortality, particularly in patients with sepsis. J Crit Care 53:218–222

    Article  CAS  Google Scholar 

  31. Putot A, Derrida SB, Zeller M, Avondo A, Ray P, Manckoundia P, Cottin Y (2018) Short-term prognosis of myocardial injury, type 1, and type 2 myocardial infarction in the emergency unit. Am J Med 131(10):1209–1219

    Article  Google Scholar 

  32. Long B, Long DA, Tannenbaum L, Koyfman A (2020) An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 38(5):998–1006

    Article  Google Scholar 

  33. Higuchi S, Suzuki M, Horiuchi Y, Tanaka H, Saji M, Yoshino H, Nagao K, Yamamoto T, Takayama M (2019) Higher non-cardiac mortality and lesser impact of early revascularization in patients with type 2 compared to type 1 acute myocardial infarction: results from the Tokyo CCU Network registry. Heart Vessels 34(7):1140–1147

    Article  Google Scholar 

  34. Putot A, Chagué F, Manckoundia P, Brunel P, Beer JC, Cottin Y, Zeller M (2020) Post-infectious myocardial infarction: does percutaneous coronary intervention improve outcomes? A Propensity Score-matched analysis. J Clin Med 9(6):1608

    Article  Google Scholar 

  35. Huang J, Wu N, Xiang Y, Wu L, Li C, Yuan Z, Jia X, Zhang Z, Zhong L, Li Y (2020) Prognostic value of chemokines in patients with newly diagnosed atrial fibrillation. Int J Cardiol 320:83–89

    Article  Google Scholar 

  36. Anzai T (2018) Inflammatory mechanisms of cardiovascular remodeling. Circ J 82(3):629–635

    Article  CAS  Google Scholar 

  37. Kim SH, Jang MJ, Hwang HY (2020) Perioperative beta-blocker for atrial fibrillation after cardiac surgery: a meta-analysis. Thorac Cardiovasc Surg 69(2):133–140

    PubMed  Google Scholar 

  38. AlTurki A, Marafi M, Proietti R, Cardinale D, Blackwell R, Dorian P, Bessissow A, Vieira L, Greiss I, Essebag V, Healey JS, Huynh T (2020) Major adverse cardiovascular events associated with postoperative atrial fibrillation after noncardiac surgery: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 13(1):e007437

    Article  Google Scholar 

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Funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI, Grant Number 17K18085 (S.H.).

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Authors and Affiliations

  1. Department of Cardiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Satoshi Higuchi & Hideaki Yoshino

  2. Department of Emergency and General Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Satoshi Higuchi, Shigeki Shibata & Hiroshi Hasegawa

  3. Division of General Internal Medicine, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan

    Yusuke Kabeya

  4. Department of Home Care Medicine, Sowa Hospital, Sagamihara, Kanagawa, Japan

    Yusuke Kabeya

  5. Division of Advanced Cardiovascular Therapeutics, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan

    Kenichi Matsushita

  6. Department of General Thoracic Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Keisei Tachibana, Ryota Tanaka & Haruhiko Kondo

  7. Department of Respiratory Surgery, Nihon University School of Medicine, Itabashi, Tokyo, Japan

    Riken Kawachi

  8. Division of Chest Surgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan

    Hidefumi Takei

  9. Department of Gastroenterological and General Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Yutaka Suzuki & Nobutsugu Abe

  10. Department of Otorhinolaryngology-Head and Neck Surgery, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan

    Yorihisa Imanishi

  11. Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Koichiro Saito

  12. Department of Anesthesiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Kiyoshi Moriyama & Tomoko Yorozu

  13. Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

    Takeaki Matsuda

Authors
  1. Satoshi Higuchi
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  2. Yusuke Kabeya
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  9. Yorihisa Imanishi
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  15. Nobutsugu Abe
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  16. Haruhiko Kondo
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  17. Takeaki Matsuda
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  18. Hideaki Yoshino
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Correspondence to Satoshi Higuchi.

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Conflict of interest

Dr. Higuchi has received lecture fees from Medtronic Japan Co., Ltd., Daiichi Sankyo Co., Ltd., and Ono Pharmaceutical Co., Ltd. The remaining authors have no disclosures to report.

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Higuchi, S., Kabeya, Y., Matsushita, K. et al. Clinical impact of perioperative atrial fibrillation on long-term recurrence of malignancy. Heart Vessels 37, 619–627 (2022). https://doi.org/10.1007/s00380-021-01954-4

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