Publication: Incident Cardiovascular Diseases Among Survivors of High-Risk Stage II-III Colorectal Cancer: A Cluster-Wide Cohort Study.
No Thumbnail Available
Identifiers
Date
2022
Authors
Lee, Shing Fung
Yip, Pui Lam
Vellayappan, Balamurugan A
Chee, Cheng Ean
Wong, Lea Choung
Wan, Eric Yuk-Fai
Chan, Esther Wai-Yin
Lee, Chak-Fei
Lee, Francis Ann-Shing
Luque-Fernandez, Miguel Angel
Advisors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
The incidence and survival of colorectal cancer (CRC) are increasing. There is an increasing number of long-term survivors, many of whom are elderly and have comorbidities. We conducted a population-based study in Hong Kong to assess the long-term cardiovascular disease (CVD) incidence associated with adjuvant fluoropyrimidine-based chemotherapy among CRC survivors. Using the population-based electronic medical database of Hong Kong, we identified adults who were diagnosed with high-risk stage II-III CRC and treated with radical surgery followed by adjuvant fluoropyrimidine-based chemotherapy between 2010 and 2019. We evaluated the cause-specific cumulative incidence of CVD (including ischemic heart disease, heart failure, cardiomyopathy, and stroke) using the flexible parametric competing risk modeling framework. The control group without a history of CVD was selected from among a noncancer random sample from primary care clinics in the same geographic area. We analyzed 1,037 treated patients with CRC and 5,078 noncancer controls. The adjusted cause-specific hazard ratio (HR) for CVD in the cancer cohort compared with the control group was 2.11 (95% CI, 1.39-3.20). The 1-, 5-, and 10-year cause-specific cumulative incidences were 2.0%, 4.5%, and 5.4% in the cancer cohort versus 1.2%, 3.0%, and 3.8% in the control group, respectively. Age at cancer diagnosis (HR per 5-year increase, 1.16; 95% CI, 1.08-1.24), male sex (HR, 1.40; 95% CI, 1.06-1.86), comorbidity (HR, 1.88; 95% CI, 1.36-2.61 for 1 comorbidity vs none, and HR, 6.61; 95% CI, 4.55-9.60 for ≥2 comorbidities vs none), diabetes (HR, 1.38; 95% CI, 1.04-1.84), hypertension (HR, 3.27; 95% CI, 2.39-4.50), and dyslipidemia/hyperlipidemia (HR, 2.53; 95% CI, 1.68-3.81) were associated with incident CVD. Exposure to adjuvant fluoropyrimidine-based chemotherapy was associated with an increased risk of CVD among survivors of high-risk stage II-III CRC. Cardiovascular risk monitoring of this group throughout cancer survivorship is advisable.
Description
MeSH Terms
Adult
Aged
Cardiovascular Diseases
Cohort Studies
Colorectal Neoplasms
Humans
Incidence
Male
Risk Factors
Survivors
Aged
Cardiovascular Diseases
Cohort Studies
Colorectal Neoplasms
Humans
Incidence
Male
Risk Factors
Survivors
DeCS Terms
CIE Terms
Keywords
cardiovascular diseases, chemotherapy, colorectal cancer, competing risk, survivors