Key result
In colorectal cancer patients undergoing surgical resection, chemotherapy was associated with a significantly lower risk of major adverse cardiac and cerebrovascular events (SHR 0.37) compared to no chemotherapy.
Why the study?
Specific predictors for long-term MACCE in colorectal cancer patients undergoing surgical resection are unclear, and whether chemotherapy increases MACCE risk was unknown.
Does chemotherapy reduce major adverse cardiac and cerebrovascular events in colorectal cancer patients undergoing surgical resection?
Cohort (n=412)
No
Does chemotherapy reduce major adverse cardiac and cerebrovascular events in colorectal cancer patients undergoing surgical resection?
Hazard Ratio: 0.37 (95% CI 0.19–0.75)
Absolute Event Rate: 4% vs 13.7%
p-value: p=0.006
In colorectal cancer patients undergoing surgical resection, chemotherapy was unexpectedly associated with a lower long-term risk of major adverse cardiac and cerebrovascular events, though diabetes and prior cardiovascular disease remain strong predictors of risk.
Lower MACCE risk with chemotherapy after colorectal cancer resection is hypothesis-generating; requires randomized confirmation before practice implications.
BACKGROUND: Colorectal 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. METHODS: In 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. RESULTS: There 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. CONCLUSIONS: Amongst 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.
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Koo et al. (2021) conducted a cohort in Colorectal cancer undergoing surgical resection (n=412). Chemotherapy vs. No chemotherapy was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (SHR 0.37, 95% CI 0.19-0.75, p=0.006). In colorectal cancer patients undergoing surgical resection, chemotherapy was associated with a significantly lower risk of major adverse cardiac and cerebrovascular events (SHR 0.37) compared to no chemotherapy.
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