Atrial fibrillation and survival in colorectal cancer
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Atrial fibrillation and survival in colorectal cancer Stewart R Walsh*, Kelly M Gladwish, Nicholas J Ward, Timothy A Justin and Neil J Keeling Address: Department of Colorectal Surgery, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk IP32 7TG, United Kingdom Email: Stewart R Walsh* - [email protected]; Kelly M Gladwish - [email protected]; Nicholas J Ward - [email protected]; Timothy A Justin - [email protected]; Neil J Keeling - [email protected] * Corresponding author
Published: 29 November 2004 World Journal of Surgical Oncology 2004, 2:40
doi:10.1186/1477-7819-2-40
Received: 31 August 2004 Accepted: 29 November 2004
This article is available from: http://www.wjso.com/content/2/1/40 © 2004 Walsh et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Survival in colorectal cancer may correlate with the degree of systemic inflammatory response to the tumour. Atrial fibrillation may be regarded as an inflammatory complication. We aimed to determine if atrial fibrillation is a prognostic factor in colorectal cancer. Patients and methods: A prospective colorectal cancer patient database was cross-referenced with the hospital clinical-coding database to identify patients who had underwent colorectal cancer surgery and were in atrial fibrillation pre- or postoperatively. Results: A total of 175 patients underwent surgery for colorectal cancer over a two-year period. Of these, 13 patients had atrial fibrillation pre- or postoperatively. Atrial fibrillation correlated with worse two-year survival (p = 0.04; log-rank test). However, in a Cox regression analysis, atrial fibrillation was not significantly associated with survival. Conclusion: The presence or development of atrial fibrillation in patients undergoing surgery for colorectal cancer is associated with worse overall survival, however it was not found to be an independent factor in multivariate analysis.
Background In general, colorectal cancer patients are three times more likely to be in atrial fibrillation preoperatively than matched controls undergoing non-colorectal cancer surgery [1,2]. It may also occur postoperatively. Recent data suggest that atrial fibrillation may be an inflammatory complication, resulting from the initiation of an inflammatory response to surgery or infection [3-6]. Colorectal cancer patients may have elevated C-reactive protein (CRP) levels [7] indicating a systemic inflammatory response. Elevated CRP levels may be associated with a worse prognosis in colorectal cancer patients [8]. Postoperative dysrhythmias may [9] or may not [10] be associ-
ated with worse survival following surgery for lung cancer. We hypothesised that atrial fibrillation (AF) is an adverse prognostic indicator in
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