Chemotherapy as a protective factor against cardiocerebrovascular disease mortality in colorectal cancer patients based on SEER database.

BACKGROUND: The impact of chemotherapy on cardiocerebrovascular disease (CCVD) outcomes in patients with colorectal cancer (CRC) remains insufficiently explored. This research aimed to clarify the association between chemotherapy and CCVD-related mortality in middle-aged and elderly CRC patients. METHODS: CRC patients aged ≥ 50 years at diagnosis were identified from the Surveillance, Epidemiology, and End Results (SEER) database for the period 2010–2015. The primary outcome was CCVD-related mortality. Survival analyses included Kaplan-Meier (KM) curves to characterize CCVD-related survival patterns and multivariate competing risks regression analysis to evaluate the independent association between chemotherapy and CCVD-related mortality. Subgroup analyses and Fine-Gray competing risks models were additionally performed to enhance the robustness of study findings. RESULTS: A total of 136 095 CRC patients were included. KM analysis showed a significantly lower cumulative risk of CCVD-related mortality in chemotherapy treatment group than in non-chemotherapy treatment group. After adjusting for age, race, gender, primary tumor site, and tumor stage, multivariate competing risks regression analysis confirmed that chemotherapy was an independent protective factor against CCVD-related mortality (sHR = 0.75, 95% CI 0.71–0.79, P < 0.001). Subgroup analyses and Fine-Gray competing risks models further validated the robustness of chemotherapy’s beneficial effect on CCVD outcomes. CONCLUSION: Chemotherapy may serve as an independent protective factor against CCVD-related mortality in CRC patients. These findings can help alleviate concerns regarding chemotherapy-associated CCVD risk in CRC management and provide novel insights for clinical decision-making and future research.