Frontiers in cardiovascular medicine · 2026
Malnutrition as an independent risk factor for fluoropyrimidine- and oxaliplatin-based chemotherapy-induced cardiovascular toxicity in colorectal cancer: a single-center retrospective cohort study.
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Zhou Xuyun, Tang Biao, Sheng Xiaomei, Chang Haixia
Аннотация
BACKGROUND: Fluoropyrimidine- and oxaliplatin-based regimens (FOLFOX/XELOX) are the standard of care for colorectal cancer (CRC) but carry significant cardiovascular toxicity. Malnutrition, present in up to 60% of post-surgical CRC patients, may amplify this toxicity through systemic inflammation and pharmacokinetic alterations; however, this relationship has not been specifically investigated.
METHODS: We conducted a retrospective cohort study of 320 CRC patients receiving FOLFOX or XELOX at the Shanghai songjiang sijing hospital (January 2020-December 2023). Nutritional status was assessed by the Nutritional Risk Screening 2002 (NRS-2002) and serum albumin. The primary endpoint was chemotherapy-induced cardiovascular toxicity events (CICVT), defined per 2022 ESC Cardio-Oncology Guidelines. Multivariable logistic regression, 1:1 propensity score matching (PSM), and receiver operating characteristic (ROC) analysis were performed. An intestinal fistula subgroup compared outcomes between total parenteral nutrition (TPN) and early enteral nutrition (EEN).
RESULTS: Nutritional risk (NRS-2002 ≥ 3) was identified in 112 patients (35.0%). CICVT occurred in 31.3% of patients at nutritional risk vs. 11.5% of well-nourished patients (p < 0.001). After PSM (89 matched pairs), malnutrition remained an independent risk factor (OR 2.93, 95% CI 1.41-6.07; p < 0.001). Multivariable analysis confirmed NRS-2002 ≥ 3 (adjusted OR 3.18, 95% CI 1.69-5.98; p < 0.001) and serum albumin < 35 g/L (adjusted OR 2.43, 95% CI 1.34-4.40; p = 0.003) as independent predictors. ROC AUC improved from 0.718 (NRS-2002 alone) to 0.764 when combined with albumin. Among 49 fistula patients, the TPN group had significantly higher CICVT rates than the EEN group (38.7% vs. 16.7%; p = 0.043).
CONCLUSION: Malnutrition is an independent and modifiable risk factor for chemotherapy-induced cardiovascular toxicity in CRC. Integrating nutritional assessment into pre-chemotherapy cardiovascular risk stratification and prioritizing early enteral nutrition in fistula patients may mitigate cardiovascular morbidity.
METHODS: We conducted a retrospective cohort study of 320 CRC patients receiving FOLFOX or XELOX at the Shanghai songjiang sijing hospital (January 2020-December 2023). Nutritional status was assessed by the Nutritional Risk Screening 2002 (NRS-2002) and serum albumin. The primary endpoint was chemotherapy-induced cardiovascular toxicity events (CICVT), defined per 2022 ESC Cardio-Oncology Guidelines. Multivariable logistic regression, 1:1 propensity score matching (PSM), and receiver operating characteristic (ROC) analysis were performed. An intestinal fistula subgroup compared outcomes between total parenteral nutrition (TPN) and early enteral nutrition (EEN).
RESULTS: Nutritional risk (NRS-2002 ≥ 3) was identified in 112 patients (35.0%). CICVT occurred in 31.3% of patients at nutritional risk vs. 11.5% of well-nourished patients (p < 0.001). After PSM (89 matched pairs), malnutrition remained an independent risk factor (OR 2.93, 95% CI 1.41-6.07; p < 0.001). Multivariable analysis confirmed NRS-2002 ≥ 3 (adjusted OR 3.18, 95% CI 1.69-5.98; p < 0.001) and serum albumin < 35 g/L (adjusted OR 2.43, 95% CI 1.34-4.40; p = 0.003) as independent predictors. ROC AUC improved from 0.718 (NRS-2002 alone) to 0.764 when combined with albumin. Among 49 fistula patients, the TPN group had significantly higher CICVT rates than the EEN group (38.7% vs. 16.7%; p = 0.043).
CONCLUSION: Malnutrition is an independent and modifiable risk factor for chemotherapy-induced cardiovascular toxicity in CRC. Integrating nutritional assessment into pre-chemotherapy cardiovascular risk stratification and prioritizing early enteral nutrition in fistula patients may mitigate cardiovascular morbidity.