Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer
BackgroundPatients with colorectal cancer (CRC) are more likely to develop cardiovascular disease (CVD) than those without cancer. Little is known regarding their CV risk after operative chemotherapy. We aimed to compare the risk of CV disease among different fluoropyrimidine derivatives.MethodsWe a...
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.880956/full |
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| author | Wen-Kuan Huang Wen-Kuan Huang Wei-Pang Ho Wei-Pang Ho Hung-Chih Hsu Hung-Chih Hsu Shu-Hao Chang Dong-Yi Chen Dong-Yi Chen Wen-Chi Chou Wen-Chi Chou Pei-Hung Chang Pei-Hung Chang Jen-Shi Chen Jen-Shi Chen Tsai-Sheng Yang Tsai-Sheng Yang Lai-Chu See Lai-Chu See Lai-Chu See |
| author_facet | Wen-Kuan Huang Wen-Kuan Huang Wei-Pang Ho Wei-Pang Ho Hung-Chih Hsu Hung-Chih Hsu Shu-Hao Chang Dong-Yi Chen Dong-Yi Chen Wen-Chi Chou Wen-Chi Chou Pei-Hung Chang Pei-Hung Chang Jen-Shi Chen Jen-Shi Chen Tsai-Sheng Yang Tsai-Sheng Yang Lai-Chu See Lai-Chu See Lai-Chu See |
| author_sort | Wen-Kuan Huang |
| collection | DOAJ |
| description | BackgroundPatients with colorectal cancer (CRC) are more likely to develop cardiovascular disease (CVD) than those without cancer. Little is known regarding their CV risk after operative chemotherapy. We aimed to compare the risk of CV disease among different fluoropyrimidine derivatives.MethodsWe assembled a nationwide cohort of patients with newly diagnosed CRC between 2004 and 2015 who received fluoropyrimidine-based adjuvant chemotherapy for resected CRC by linking the Taiwan Cancer Registry (TCR), National Health Insurance Research Database (NHIRD), and Taiwan Death Registry (TDR). All eligible patients were followed from CRC diagnosis (index date) until a CV event, death, loss to follow-up, or December 31st 2018, whichever came first. CV outcomes included acute myocardial infarction (AMI), life-threatening arrhythmia (LTA), congestive heart failure (CHF), and ischemic stroke (IS). We used stabilized inverse probability of treatment weighting using propensity score (SIPTW) to balance all covariates among the three chemotherapy groups: tegafur-uracil (UFT), non-UFT, and mixed. In addition, survival analysis was conducted to examine the association between study outcomes and chemotherapy groups.ResultsFrom 2004 to 2015, 10,615 (32.8%) patients received UFT alone, 14,511 (44.8%) patients received non-UFT, and 7,224 (22.3%) patients received mixed chemotherapy. After SIPTW, the UFT group had significantly lower all-cause mortality and cancer-related death rates than the other two chemotherapy groups. However, the UFT group had significantly higher rates of cancer death, ischemic stroke, and heart failure than those of the other two chemotherapy groups. The UFT group also had a significantly higher AMI rate than the mixed group. There was no significant difference in LTA among the three groups. Similar findings were observed in the subgroup analysis (stage II and age <70 years, stage II and age ≥70 years, stage III and age <70 years, stage III and age ≥70 years) as the overall population was observed.ConclusionHigher heart failure and ischemic stroke rates were found in the UFT group than in the other two chemotherapy groups, especially those with stage III CRC and ≥70 years of age. Careful monitoring of this subset of patients when prescribing UFT is warranted. |
| first_indexed | 2024-04-14T06:01:28Z |
| format | Article |
| id | doaj.art-1e8af4f764f54b5f9dbb009cce46c7ea |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-14T06:01:28Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1e8af4f764f54b5f9dbb009cce46c7ea2022-12-22T02:08:44ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-08-01910.3389/fcvm.2022.880956880956Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancerWen-Kuan Huang0Wen-Kuan Huang1Wei-Pang Ho2Wei-Pang Ho3Hung-Chih Hsu4Hung-Chih Hsu5Shu-Hao Chang6Dong-Yi Chen7Dong-Yi Chen8Wen-Chi Chou9Wen-Chi Chou10Pei-Hung Chang11Pei-Hung Chang12Jen-Shi Chen13Jen-Shi Chen14Tsai-Sheng Yang15Tsai-Sheng Yang16Lai-Chu See17Lai-Chu See18Lai-Chu See19Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Public Health, College of Medicine, Chang Gung University, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Keelung, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDepartment of Public Health, College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, TaiwanBiostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, TaiwanBackgroundPatients with colorectal cancer (CRC) are more likely to develop cardiovascular disease (CVD) than those without cancer. Little is known regarding their CV risk after operative chemotherapy. We aimed to compare the risk of CV disease among different fluoropyrimidine derivatives.MethodsWe assembled a nationwide cohort of patients with newly diagnosed CRC between 2004 and 2015 who received fluoropyrimidine-based adjuvant chemotherapy for resected CRC by linking the Taiwan Cancer Registry (TCR), National Health Insurance Research Database (NHIRD), and Taiwan Death Registry (TDR). All eligible patients were followed from CRC diagnosis (index date) until a CV event, death, loss to follow-up, or December 31st 2018, whichever came first. CV outcomes included acute myocardial infarction (AMI), life-threatening arrhythmia (LTA), congestive heart failure (CHF), and ischemic stroke (IS). We used stabilized inverse probability of treatment weighting using propensity score (SIPTW) to balance all covariates among the three chemotherapy groups: tegafur-uracil (UFT), non-UFT, and mixed. In addition, survival analysis was conducted to examine the association between study outcomes and chemotherapy groups.ResultsFrom 2004 to 2015, 10,615 (32.8%) patients received UFT alone, 14,511 (44.8%) patients received non-UFT, and 7,224 (22.3%) patients received mixed chemotherapy. After SIPTW, the UFT group had significantly lower all-cause mortality and cancer-related death rates than the other two chemotherapy groups. However, the UFT group had significantly higher rates of cancer death, ischemic stroke, and heart failure than those of the other two chemotherapy groups. The UFT group also had a significantly higher AMI rate than the mixed group. There was no significant difference in LTA among the three groups. Similar findings were observed in the subgroup analysis (stage II and age <70 years, stage II and age ≥70 years, stage III and age <70 years, stage III and age ≥70 years) as the overall population was observed.ConclusionHigher heart failure and ischemic stroke rates were found in the UFT group than in the other two chemotherapy groups, especially those with stage III CRC and ≥70 years of age. Careful monitoring of this subset of patients when prescribing UFT is warranted.https://www.frontiersin.org/articles/10.3389/fcvm.2022.880956/fullcardiovascular diseasefluoropyrimidinecolorectal cancermortalityadjuvant chemotherapy |
| spellingShingle | Wen-Kuan Huang Wen-Kuan Huang Wei-Pang Ho Wei-Pang Ho Hung-Chih Hsu Hung-Chih Hsu Shu-Hao Chang Dong-Yi Chen Dong-Yi Chen Wen-Chi Chou Wen-Chi Chou Pei-Hung Chang Pei-Hung Chang Jen-Shi Chen Jen-Shi Chen Tsai-Sheng Yang Tsai-Sheng Yang Lai-Chu See Lai-Chu See Lai-Chu See Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer Frontiers in Cardiovascular Medicine cardiovascular disease fluoropyrimidine colorectal cancer mortality adjuvant chemotherapy |
| title | Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| title_full | Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| title_fullStr | Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| title_full_unstemmed | Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| title_short | Risk of cardiovascular disease among different fluoropyrimidine-based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| title_sort | risk of cardiovascular disease among different fluoropyrimidine based chemotherapy regimens as adjuvant treatment for resected colorectal cancer |
| topic | cardiovascular disease fluoropyrimidine colorectal cancer mortality adjuvant chemotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.880956/full |
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