Abstract
BackgroundColorectal cancer patients undergoing surgical resection are at increased short-term risk of post-operative adverse events. However, specific predictors for long-term major adverse cardiac and cerebrovascular events (MACCE) are unclear. We hypothesised that patients who receive chemotherapy are at higher risk of MACCE than those who did not.MethodsIn this retrospective study, 412 patients who underwent surgical resection for newly diagnosed colorectal cancer from January 2013 to April 2015 were grouped according to chemotherapy status. MACCE was defined as a composite of cardiovascular death, myocardial infarction, stroke, unplanned revascularisation, hospitalisation for heart failure or angina. Predictors of MACCE were identified using competing risks regression, with non-cardiovascular death a competing risk.ResultsThere were 200 patients in the chemotherapy group and 212 patients in the non-chemotherapy group. The overall prevalence of prior cardiovascular disease was 20.9%. Over a median follow-up duration of 5.1 years from diagnosis, the incidence of MACCE was 13.3%. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE (subdistribution hazard ratio, 2.56; 95% CI, 1.48-4.42) and 2.38 (95% CI, 1.36-4.18) respectively. The chemotherapy group was associated with a lower risk of MACCE (subdistribution hazard ratio, 0.37; 95% CI, 0.19-0.75) compared to the non-chemotherapy group.ConclusionsAmongst colorectal cancer patients undergoing surgical resection, there was a high incidence of MACCE. Diabetes mellitus and prior cardiovascular disease were associated with an increased risk of MACCE. Chemotherapy was associated with a lower risk of MACCE, but further research is required to clarify this association.
Highlights
As colorectal cancer survival continues to improve, the burden of cardiovascular disease has increased amongst survivors [1]
The chemotherapy group was significantly younger than the nonchemotherapy group
The prevalence of prior cardiovascular disease within the overall cohort was more than 20%, and was significantly lower in the chemotherapy group
Summary
As colorectal cancer survival continues to improve, the burden of cardiovascular disease has increased amongst survivors [1]. Colorectal cancer patients are potentially at high cardiovascular risk when undergoing colorectal surgery. This is due to the presence of multiple shared cardiovascular risk factors, chronic inflammation from cancer, and well-established cardio-toxic effects of the chemotherapy regimens comprising of anti-metabolite regimens such as 5-fluorouracil or its pro-drug capecitabine [6]. Existing studies examining postoperative outcomes were either not specific to colorectal cancer surgery, or focused mainly on short-term mortality outcomes. These studies did not account for the potential effect of chemotherapy on outcomes [4, 5]. Colorectal cancer patients undergoing surgical resection are at increased short-term risk of post-operative adverse events. We hypothesised that patients who receive chemotherapy are at higher risk of MACCE than those who did not
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