The Risk of Cardiovascular Adverse Outcomes in Patients With Thymoma or Thymic Carcinoma Receiving Cancer Therapy

Thymic neoplasms are often treated with radiation and anthracyclines. Data on cardiovascular events remain limited. The objective of this study is to assess the incidence and predictors of long-term cardiovascular events in patients with thymic neoplasms.

This retrospective cohort study included consecutive patients diagnosed with thymic neoplasms between 2004 and 2021. The primary outcome was a composite of the first myocardial infarction, obstructive coronary artery disease (CAD) without infarction, heart failure, atrial fibrillation, stroke, pacemaker implantation, or cardiovascular death. Cancer therapy was modeled as a time-varying covariate. Competing risk models and multivariable extended Cox regression were used.

Among 410 patients (median age 57 y; 50% women) followed for a maximum of 19 years (median 6.9 y), the cumulative incidence of the primary outcome was 11.3% (95% confidence interval [CI] 8.6%-15.0%), 19.5% (15.4%-24.6%), and 28.0% (22.6%-34.8%) at 5, 10, and 14 years of follow-up, respectively. Among the 84 patients with events, some experienced multiple events: heart failure (n = 39), myocardial infarction (n = 20), atrial fibrillation (n = 25), stroke (n = 18), obstructive CAD without infarction (n = 6), pacemaker implantation (n = 6), and cardiovascular death (n = 6). Radiation alone (hazard ratio [HR] 2.9, 95% CI 1.5-5.9, p = 0.003), anthracyclines alone (HR 4.6, 95% CI 1.1-18.8, p = 0.03), and both therapies combined (HR 12.2, 95% CI 4.5-32.7, p < 0.001) were independently associated with increased cardiovascular risk. Baseline cardiovascular comorbidities also increased risk (HR 2.8, 95% CI 1.3-6.2). During follow-up, 94 patients (22.9%) died, most often from recurrent or progressive cancer (56.4%).

Cardiovascular events are frequent among patients with thymic neoplasms, particularly those treated with radiation and anthracyclines. However, cancer-related mortality remained the predominant cause of death. Long-term cardiovascular surveillance and risk mitigation strategies should be considered.