Multidimensional Determinants of Cardiovascular Mortality in Tongue Cancer Survivors: A Population – Based Cohort Study Leveraging SEER Data

Background. Tongue cancer (TC) is a prevalent head and neck malignancy with significant morbidity and mortality. Epidemiological studies indicate that mortality causes in TC patients shift over time: cancer-related deaths dominate early stages, while long-term survivors face increasing non-cancer mortality, primarily cardiovascular disease (CVD). Treatment modalities such as radiotherapy (RT) and chemotherapy may exacerbate CVD risks, compounded by sociodemographic and tumor-related heterogeneity.
Objective. This study aimed to quantify CVD-related mortality risk in TC survivors, identify high-risk subgroups, and explore multidimensional determinants using population-level data.
Methods. A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database (2000–2021). A total of 7,691 TC patients were included after applying exclusion criteria.Standardized mortality ratios (SMRs) and excess risks were calculated by comparing observed CVD deaths to expected rates in age-, sex-, and race-matched general populations. Nelson-Aalen cumulative hazard curves and Poisson regression were employed for risk stratification.
Results. CVD-related mortality in TC survivors was significantly elevated (SMR = 3.16, 95% CI: 3.15–3.17), with pronounced heterogeneity across subgroups. Radiotherapy-exposed patients (SMR = 11.48), those with distant metastases (SMR = 7.05), and socially vulnerable populations – Black individuals (SMR =5.76) and widowed/separated patients (SMR = 15.92–16.18) – faced the highest risks. Ischemic heart disease dominated CVD deaths (42.9%, SMR =15.61), followed by cerebrovascular diseases (17.3%, SMR = 13.69). Non-chemotherapy patients exhibited elevated risks (SMR = 7.33), potentially due to comorbidities or unmeasured treatment interactions.
Conclusion. TC survivors face a substantially increased CVD mortality burden, driven by treatment toxicity, tumor biology, and sociodemographic disparities. Integrating cardiovascular surveillance into survivorship care is critical, particularly for irradiated patients and socially vulnerable groups. Future research should prioritize mechanistic studies, risk prediction models, and equity-focused interventions to mitigate dual cancer-CVD burdens. Key words: TC SEER Cardiovascular Disease
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. The study has not received any funding.