Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment

  • D. Herrero Rivera
  • J. M. Nieto-Guerrero Gómez
  • J. Cacicedo Fernández de Bobadilla
  • D. Delgado
  • E. Rivin del Campo
  • J. M. Praena-Fernández
  • R. Bernabé Caro
  • M. J. Ortiz Gordillo
  • M. C. Fernández Fernández
  • J. L. Lopez GuerraEmail author
Research Article



Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC).

Materials and methods

Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3–60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12–70]); and 50 (15%) patients underwent surgery.


Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31–88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025).


HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.


Cardiovascular disease Non-small cell lung cancer Outcome Prognosis Thromboembolism events 



This work was supported by grants from ISCIII (Fis: PI13/01155, PI16/02104) and Consejeria de Salud of the Junta de Andalucia (PI-0096-2012).

Compliance with ethical standards

Conflict of interest

All persons listed as authors have given their approval for the submission of the paper. Authors declare that we do not have any financial support or relationships that may suppose conflict of interest.

Human rights and animal participants

The information collected in this research has been obtained exclusively from human participants with the previous acceptance of these through informed consent. No animals were involved in this study.

Informed consent

Informed consent has been obtained from all individual participants included in the study and the research was approved by the Institutional Review Board.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  • D. Herrero Rivera
    • 1
  • J. M. Nieto-Guerrero Gómez
    • 2
  • J. Cacicedo Fernández de Bobadilla
    • 3
  • D. Delgado
    • 2
  • E. Rivin del Campo
    • 4
  • J. M. Praena-Fernández
    • 5
  • R. Bernabé Caro
    • 1
  • M. J. Ortiz Gordillo
    • 2
    • 6
  • M. C. Fernández Fernández
    • 2
  • J. L. Lopez Guerra
    • 2
    • 6
    Email author
  1. 1.Department of Medical OncologyUniversity Hospital Virgen del RocíoSevilleSpain
  2. 2.Department of Radiation OncologyUniversity Hospital Virgen del RocíoSevilleSpain
  3. 3.Department of Radiation OncologyCruces University HospitalBarakaldoSpain
  4. 4.Department of Radiation OncologyTenon University HospitalParisFrance
  5. 5.Methodology UnitUniversity Hospital Virgen del RocíoSevilleSpain
  6. 6.Instituto de Biomedicina de Sevilla (IBIS/HUVR, CSIC/Universidad de Sevilla)SevilleSpain

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