Cardiovascular mortality risk in primary penile cancer patients: A retrospective cohort study from 2000 to 2021.

7 Background: Primary penile cancer is a rare malignancy, representing less than 1% of all cancers in men in developed countries. The disease predominantly affects older males and is frequently associated with risk factors such as human papillomavirus (HPV) infection, chronic inflammation, smoking, and poor hygiene. Given the age and comorbidities of patients diagnosed with penile cancer, cardiovascular disease (CVD) is a significant concern. Penile cancer patients often present with multiple risk factors for CVD, including advanced age, smoking, obesity, and pre-existing hypertension. Despite improvements in cancer-specific survival, non-cancer causes of death, particularly cardiovascular mortality (CVM), may disproportionately affect these patients. Understanding the cardiovascular mortality in penile cancer patients is crucial for holistic care and survivorship. Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with primary penile cancer who experienced cardiovascular mortality (CVM) between 2000 and 2021. CVM was defined as mortality resulting from heart disease, hypertension (without concomitant heart disease), cerebrovascular disease, atherosclerosis, aortic aneurysm and dissection, and other diseases of the arteries, arterioles, and capillaries. Standardized mortality rates (SMR) were calculated to assess the relative risk of CVM among penile cancer patients compared to the general population. Absolute excess risk (AER) was also estimated to quantify the additional number of CVM-related deaths attributed to this patient population. Results: Out of a total cohort of 6,889 patients diagnosed with primary penile cancer, 689 experienced cardiovascular mortality. Patients with Non-cardiovascular death and patients with unknown ag, race and cancer stage were excluded. We compared the CVM of each group to the general US population. In our cohort based on race we didn't note statistically significant increase in CVD SMRs. Regarding race American Indians/Alaska Natives has (SMR 0.99, CI 0.24-3.98), Asians or Pacific Islanders (SMR 0.99 CI 0.68-1.46), Blacks (SMR 0.99 CI 0.75-1.33), Whites (SMR 1.00 CI 0.91-1.08). In terms of age, patients aged 30-50 years (n=27) had SMR of 0.99 (CI 0.68-1.44), 50-79 year (n=359) had SMR of 0.99 (CI 0.90-1.10), while 80 years and above (n=222) had SMR of 1.00 (CI 0.87-1.14). Conclusions: Our analysis evaluates the burden of CVD-related mortality in patients with primary penile carcinoma. In this cohort, no statistically significant increase in cardiovascular mortality was observed when compared to the general U.S. population, stratified by race and age. Further research is required to better understand potential associations or disparities and to identify any underlying factors that may influence cardiovascular outcomes in this population.