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Peer-reviewedCC BYBMC cancer

Assessing mortality risk in colorectal cancer survivors with congestive heart failure: a cohort study from the Taiwan Cancer Registry.

  • Mitsuhiro Koseki1,2
  • Ching-Chieh Yang3,4,5
  • I-Che Feng1
  • Wei-Chieh Lee6
  • Chien-Liang Lin7
  • Ying-Jia Lin8
  • Jhi-Joung Wang8
  • Chung-Han Ho9,10,11
11 affiliations
  1. 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
  2. 2Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
  3. 3Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.
  4. 4Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
  5. 5Cancer Center, Chi Mei Medical Center, Tainan, Taiwan.
  6. 6Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
  7. 7Division of Hematology‑Oncology, Department of Internal Medicine, Chi Mei Hospital, Liouying District, Tainan, Taiwan.
  8. 8Department of Medical Research, Chi Mei Medical Center Tainan, Tainan City, Taiwan.
  9. 9Department of Medical Research, Chi Mei Medical Center Tainan, Tainan City, Taiwan. [email protected].
  10. 10Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan. [email protected].
  11. 11Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan. [email protected].
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Abstract

Background

The rising incidence of colorectal cancer (CRC) and cardiovascular diseases, driven by aging populations and lifestyle changes, highlights congestive heart failure (CHF) as a critical comorbidity that significantly affects survival and treatment decisions in CRC patients. CHF not only affects survival outcomes but also complicates clinical decision-making. This study aims to investigate the impact of CHF on mortality among CRC survivors and explore potential factors of mortality.Methods

This cohort study analyzed data from the Taiwan Cancer Registry and National Health Insurance Research Database. CRC patients aged 20 years or older (ICD-10-CM: C18-C20) who survived at least five years after diagnosis were included. After a 1:4 exact matching based on age, sex, and clinical stage, Cox regression was used to estimate mortality risk between CRC survivors with and without CHF.Results

A total of 535 CRC survivors with CHF and 2140 without CHF were enrolled in this study after matching. CRC survivors with CHF had a significantly higher overall mortality rate than those without CHF (36.64% vs. 15.23%, p < 0.001). After adjusting for potential confounders, CRC survivors with CHF had 1.93-folds risk of mortality (95% CI: 1.54-2.41, p < 0.001) compared to those without CHF. Subgroup analyses by sex, age, clinical stage, Charlson Comorbidity Index (CCI), and treatment types also show that CRC survivors with CHF had significantly higher mortality risk than those without CHF. The top three highest mortality risk ratios were observed in subgroups with a CCI score of 0 (AHR: 2.63, 95% CI: 1.08-6.39), age < 65 years (AHR: 1.87, 95% CI: 1.23-5.57), and advanced clinical stage (AHR: 2.03, 95% CI: 1.51-2.72).Conclusion

CRC survivors with CHF demonstrated significantly higher overall mortality compared to those without CHF. This finding presented the prognostic impact of CHF in CRC survivors, so integrated care and early cardiovascular monitoring are essential to improve long-term outcomes.

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Cite

BibTeXRIS
BibTeX
@article{koseki2026assessing,
  title = {{Assessing mortality risk in colorectal cancer survivors with congestive heart failure: a cohort study from the Taiwan Cancer Registry.}},
  author = {Mitsuhiro Koseki and Ching-Chieh Yang and I-Che Feng and Wei-Chieh Lee and Chien-Liang Lin and Ying-Jia Lin and Jhi-Joung Wang and Chung-Han Ho},
  journal = {BMC cancer},
  year = {2026},
  month = aug,
  doi = {10.1186/s12885-026-16717-5},
  url = {https://europepmc.org/article/MED/43009806},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Assessing mortality risk in colorectal cancer survivors with congestive heart failure: a cohort study from the Taiwan Cancer Registry.
AU  - Mitsuhiro Koseki
AU  - Ching-Chieh Yang
AU  - I-Che Feng
AU  - Wei-Chieh Lee
AU  - Chien-Liang Lin
AU  - Ying-Jia Lin
AU  - Jhi-Joung Wang
AU  - Chung-Han Ho
PY  - 2026
DA  - 2026/08/12
JO  - BMC cancer
DO  - 10.1186/s12885-026-16717-5
UR  - https://europepmc.org/article/MED/43009806
AB  - Background  The rising incidence of colorectal cancer (CRC) and cardiovascular diseases, driven by aging populations and lifestyle changes, highlights congestive heart failure (CHF) as a critical comorbidity that significantly affects survival and treatment decisions in CRC patients. CHF not only affects survival outcomes but also complicates clinical decision-making. This study aims to investigate the impact of CHF on mortality among CRC survivors and explore potential factors of mortality.Methods  This cohort study analyzed data from the Taiwan Cancer Registry and National Health Insurance Research Database. CRC patients aged 20 years or older (ICD-10-CM: C18-C20) who survived at least five years after diagnosis were included. After a 1:4 exact matching based on age, sex, and clinical stage, Cox regression was used to estimate mortality risk between CRC survivors with and without CHF.Results  A total of 535 CRC survivors with CHF and 2140 without CHF were enrolled in this study after matching. CRC survivors with CHF had a significantly higher overall mortality rate than those without CHF (36.64% vs. 15.23%, p < 0.001). After adjusting for potential confounders, CRC survivors with CHF had 1.93-folds risk of mortality (95% CI: 1.54-2.41, p < 0.001) compared to those without CHF. Subgroup analyses by sex, age, clinical stage, Charlson Comorbidity Index (CCI), and treatment types also show that CRC survivors with CHF had significantly higher mortality risk than those without CHF. The top three highest mortality risk ratios were observed in subgroups with a CCI score of 0 (AHR: 2.63, 95% CI: 1.08-6.39), age < 65 years (AHR: 1.87, 95% CI: 1.23-5.57), and advanced clinical stage (AHR: 2.03, 95% CI: 1.51-2.72).Conclusion  CRC survivors with CHF demonstrated significantly higher overall mortality compared to those without CHF. This finding presented the prognostic impact of CHF in CRC survivors, so integrated care and early cardiovascular monitoring are essential to improve long-term outcomes.
SN  - 1471-2407
ER  -