Cardiovascular Outcomes in the Patients With Colorectal Cancer: A Multi-Registry-Based Cohort Study of 197,699 Cases in the Real World

Abstract

PurposeWe aimed to investigate the mortality patterns and quantitatively assess the risks of cardiovascular death (CVD) in patients with colorectal cancer (CRC). We also established a competing-risk model to predict the probability of CVD for patients with CRC.Patients and MethodsPatients with CRC who diagnosed between 2007 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in the present study. The cumulative incidence function (CIF) was used for CVD and other causes of death, and Gray’s test was used to determine the subgroup difference in CIF. The Fine-Gray proportional subdistribution hazards model was used for identifying independent risk factors for CVD. A novel competing-risk model was established to evaluate the probability of CVD for patients with CRC. The performance of the nomogram was measured by concordance index (C-index), calibration curve, decision curve analysis (DCA), and risk stratification.ResultsAfter a median follow-up of 37.00 months, 79,455 deaths occurred, of whom 56,185 (70.71%) succumbed to CRC and 23,270 (29.29%) patients died due to non-CRC, among which CVD accounted for 9,702 (41.69%), being the major cause of non-cancer deaths. The 1-, 3-, and 5-year cumulative rates for CVD were 12.20, 24.25, and 30.51%, respectively. In multivariate analysis, age, race, marital status, tumor size, tumor stage, advanced stage, surgery, and chemotherapy were independent risk factors of CVD among patients with CRC. The nomogram was well calibrated and had good discriminative ability, with a c-index of 0.719 (95% CI, 0.738–0.742) in the training cohort and 0.719 (95% CI, 0.622–0.668) in the validation cohort. DCA demonstrated that nomogram produced more benefit within wide ranges of threshold probabilities for 1-, 3-, and 5-year CVD, respectively.ConclusionThis study was the first to analyze the CIF and risk factors for CVD among CRC based on a competing-risk model. We have also built the first 1-, 3-, and 5-year competing nomogram for predicting CVD. This nomogram had excellent performance and could help clinicians to provide individualized management in clinical practice.

Nomogram model for predicting cause-specific mortality in patients with Early-Onset Colorectal Cancer: a competing risk analysis Insight from the SEER Database and a Chinese Cohort.

“…In recent years, socioeconomic factors, including cultural and social values, insurance status, educational level, and employment status, have increasingly become a focus of attention in the medical eld [45] . We observed that marital status is a risk factor for both cancer-speci c mortality (CSM) and overall survival (OCM).…”

Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

“…Harrell’s concordance C-index was calculated using bootstrap resampling (1000 replications) to measure the discriminatory ability of the nomograph. Consistency was gauged by calibration curves, while the predictive effect of the model was verified using the ROC curve and AUC[ 5 , 24 ]. In addition, the net clinical benefit of the nomograph was estimated via decision curve analysis (DCA).…”

“…In the last decade, CVD has been recognized as one of the most frequent advanced comorbidities of cancer treatment[ 5 ]. Advances in therapeutic approaches, especially the advent of immunotherapies, have revolutionized cancer treatment, allowing the lifespan of cancer patients to be extended, but at the same time leading to millions of cancer survivors currently at risk of developing CVD[ 6 - 8 ].…”

Cancer survivor late-effects, chronic health problems after cancer treatment: what’s the evidence from population and registry data and where are the gaps?

“…This was higher with higher intensity treatment (six cycles) [18]. CVD was also observed in those treated for colorectal cancer, with 1-, 3- and 5-year cumulative rates for CVD being 12.20%, 24.25% and 30.51%, respectively [19]. The prevalence of ischaemic stroke was three-times higher in those treated for nasopharyngeal cancer than those in a comparative non-cancer population [15].…”

“…Risk was highest in the first year after diagnosis (HR = 7.47, 95% CI 6.66–8.37) and reduced overtime. Still an increased risk at 5 years post treatment Association between AKI and colorectal cancer treatment was greater for younger patients, men and those with pre-existing chronic kidney disease Zhang et al 2022 [19]Sweden Retrospective registry study of 197 699 people diagnosed with colorectal cancer between 2007 and 2015. Study explored the mortality patterns and risks of cardiovascular disease events No comparative normative data Median follow-up of 37 months 79 455 deaths occurred of which 29.29% died through non-cancer events which CVD made up 41.69% The 1, 3 and 5-year cumulative rate for CVD was 12.20%, 24.25% and 30.51%, respectively Age, race, marital status, tumour size, stage, surgery, and chemotherapy were independent risk factors of CVD Chen et al 2019 [15]Taiwan Retrospective cohort study of 3016 people diagnosed with nasopharyngeal cancer between 2005 and 2012.…”