ABDOMINAL AORTIC-ANEURYSMS AND MALIGNANT NEOPLASIA - DOUBLE JEOPARDY

Background. This study was performed to determine whether there is a s ignificant association between abdominal aortic aneurysms (AAAs) and m alignancy and to determine the impact of malignancy on late survival i n patients with AAA. Methods. We studied 126 men undergoing AAA repair and compared ed them with 99 men undergoing aortofemoral bypass (AFB) for occlusive disease and with 100 men undergoing herniorrhaphy durin g the same period. Results. Fifty-one (40%) patients with AAA, 23 (23% ) patients undergoing AFB, and 21 (21%) patients undergoing herniorrha phy were diagnosed with cancer (p = 0.002). By life table analysis the proportion of subjects remaining cancer free at 5 years was 0.60 +/- 0.05 for AAA, 0.83 +/- 0.04 for AFB, and 0.81 +/- 0.04 for herniorrhap hy (p = 0.004). Multivariate analysis selected four independent risk f actors for cancer: presence of, AAA (p = 0.003, odds ratio 1.4, confid ence interval [Cl] 1.2 to 1.7), age (p = 0.001, odds ratio per year 1. 1, CI 1.0 to 1.1), smoking (I = 0.04, odds ratio 1.5, CI 1.0 to 2.2), and hypertension (p = 0.04, odds ratio 0.73 CI 0.5 to 1.0). Cancer. de aths accounted for 32% of late deaths in patients with AAA, which was not different compared with 26% of late deaths in patients undergoing AFB and 36% of late deaths In patients undergoing herniorrhaphy. Five- year cancer-free survival was 0.44 +/- 0.05 for patients with AAA, 0.6 4 +/- 0.05 for patients undergoing AFB, and 0.70 +/- 0.05 for patients undergoing herniorrhaphy (I < 0.001, AAA versus herniorrhaphy only). Conclusions. Cancer is more prevalent in men with AAA than in men unde rgoing AFB or herniorrhaphy. The presence of AAA appears to be an inde pendent risk factor for cancer Despite the higher cancer prevalence in patients with AAA, cardiovascular disease accounted for the largest n umber of late deaths in this series, minimizing differences in cancer- free survival between patients with AAA and patients undergoing AFB.