Influence of unruptured abdominal aortic aneurysm (AAA) diagnosis on risk of malignant neoplasms in patients with obesity and ischemic heart disease.

Abstract

e23344 Background: Obesity is associated with risk factors for abdominal aortic aneurysm (AAA), which is associated with cigarette smoking that predisposes to ischemic heart disease and cancer. Diagnosis of malignancy in a patient with an AAA may present a therapeutic dilemma depending on which pathology is more life-threatening. The risk and incidence of cancer in this unique population is unknown. Methods: We retrospectively queried the TriNetX Global Collaborative network across 141 healthcare organizations from Jan 2003 – Dec 2022 for adults ≥45-89 years) diagnosed with ischemic heart disease, and obesity based on ICD-10 codes. We then created two cohorts: one with unruptured AAA, and the other without AAA within the period. We performed propensity score matching (PSM) for 31 covariates and compared mortality and new diagnoses of neoplasms between cohorts. The primary outcome was all-cause mortality. Other outcomes included 20 common solid and hematological malignancies, and the incidence proportion was calculated in the AAA population. Logistic regression analysis was used to calculate the risk ratios (RR), 95% confidence intervals (CI), and p-values, with outcomes measured from the index event at 6 months, 1, and 3 years. Results: The AAA cohort had 36,869 patients, while the control cohort had 1,015,872 patients. After PSM, both cohorts had 36,747 patients. At 3 years, the AAA cohort had higher risk of all-cause mortality (RR 1.29; 1.25 – 1.34, p < 0.0001), lung cancer (RR 1.40;1.25 – 1.57, p < 0.0001), bladder cancer (RR 1.42; 1.20 – 1.68, p < 0.0001), hepatobiliary cancers (RR 1.31; 1.05 – 1.62, p = 0.0156) and renal cell cancer (RR 1.38; 1.14 – 1.67, p = 0.0011). These differences remained significant at 6 months and 1 year. Esophageal cancer was significantly increased at 6 months and 3 years, Lymphoid leukemia risk was increased only at 1 year. The difference in cervical cancer (RR 2.07; 1.10 – 3.92, p = 0.0221), and non-Hodgkin’s lymphoma (RR 1.40; 1.10 – 1.78, p = 0.0056), was significantly increased only at 3 years, The differences between both cohorts for other malignant neoplasms did not reach statistical significance at any time. The highest 10-year incidence proportion from 2013 to 2022 among the AAA cohort was seen in Lung cancer with a 72% increase (0.29 % to 1.04%). Conclusions: AAA in obese patients with ischemic heart disease was associated with higher risk of mortality, lung, bladder, hepatobiliary, and renal cell cancer with elevated incidences of these cancers compared to obese patients without AAA. There is a need to emphasize age-appropriate screening for these patients, especially those with a history of tobacco use, and if further imaging is obtained for surgical evaluation of a AAA.