2879 - Elevated Cerebrovascular Risk in Post-Radiotherapy Head and Neck Cancer Survivors: A Real-World Data Analysis from TriNetX

10:45am - 12:00pm PT

Hall F

Screen: 18

POSTER

Presenter(s)

Jeng-You Wu, MD, MBA - Taipei Municipal WanFang Hospital, Taipei, Taipei

J. Y. Wu^1,2, C. Y. E. Su^1,3, M. H. Hsu^4,5, and T. H. Chang¹; ¹Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ²Wan Fang Hospital, Taipei Medical University, Department of Radiation Oncology, Taipei, Taiwan, ³Institute of Biomedical Informatics, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ⁴Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan, ⁵Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

Purpose/Objective(s): Head and neck cancer (HNCA) survivors face an elevated risk of cerebrovascular accidents (CVA) due to preexisting cardiovascular risk factors, treatment-related vascular damage, and lifestyle behaviors. Radiotherapy (RT), a cornerstone of HNCA treatment, has been associated with radiation-induced vascular toxicity, leading to carotid artery stenosis, endothelial dysfunction, and accelerated atherosclerosis, all contributing to increased cerebrovascular complications. Despite growing recognition of this risk, large-scale real-world data analyses are needed to better quantify the association between RT and CVA risk. This study utilized the TriNetX global federated health research network to assess CVA risk in HNCA survivors. We compared CVA incidence between HNCA patients treated with RT and those who did not receive RT to provide clinically relevant insights for risk stratification, surveillance, and long-term management.

Materials/Methods: A retrospective Compare Outcomes Analysis was conducted using the TriNetX Global Collaborative Network, which includes 142 healthcare organizations. Two cohorts were defined based on electronic medical records: Cohort 1 (HNCA patients who received RT, n = 25,424) and Cohort 2 (HNCA patients who did not receive RT, n = 48,197). Patients were identified based on HNCA diagnosis (ICD-10: C00-C14) and RT status (procedure codes for RT administration). The index event was the date of HNCA diagnosis, and CVA incidence was assessed over a predefined follow-up period. Statistical analyses included Measures of Association and Kaplan-Meier survival analysis, adjusting for demographic and clinical variables.

Results: Demographic characteristics were comparable between the cohorts, with the RT group having a mean age of 69.9 ± 11.9 years compared to 60.6 ± 15.7 years in the non-RT group. Males comprised 73.83% of the RT cohort and 62.71% of non-RT, while 58.05% of RT patients and 58.95% of non-RT patients were non-Hispanic or Latino. Patients treated with RT exhibited a significantly higher risk of CVA than those who did not receive RT. The RT cohort had a CVA risk difference of 7.29% (95% CI: 6.706%–7.752%, p < 0.0001), a risk ratio of 2.051 (95% CI: 1.951–2.155), and an odds ratio of 2.223 (95% CI: 2.103–2.35). Kaplan-Meier analysis, using CVA occurrence as the endpoint, demonstrated a 5-year CVA-free probability of 26.19% in the RT cohort compared to 67.34% in the non-RT cohort (p < 0.0001). The hazard ratio for CVA was 1.8 (95% CI: 1.708–1.897, p = 0.1300), indicating a substantial increase in CVA risk associated with RT.

Conclusion: HNCA patients receiving RT have a significantly increased risk of CVA, emphasizing the need for long-term cardiovascular monitoring and risk mitigation strategies in this population. These findings underscore the importance of integrating CVA risk assessment into survivorship care for HNCA patients treated with RT. Further prospective studies are warranted.