ArticleFrontiers in cardiovascular medicine2026
Malnutrition as an independent risk factor for fluoropyrimidine- and oxaliplatin-based chemotherapy-induced cardiovascular toxicity in colorectal cancer: a single-center retrospective cohort study.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 ( 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.
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