To investigate the incidence rate of and risk factors for cardiotoxicity of fluorouracil-based chemotherapy in patients with locally advanced or metastatic gastric cancer, and the effects of combination with and without taxanes.

We retrospectively analyzed consecutive patients with locally advanced or metastatic gastric cancer treated with multiple cycles of fuorouracil-based chemotherapy at Peking University First Hospital from January 2011 to October 2016. The incidence rate of cardiotoxicity and the difference in cardiotoxicity events and severe cardiac events between the regimens in combination with or without taxanes were analyzed. Propensity score matching (PSM) was used to match patients with severe cardiac toxicity at a 1:2 ratio with patients without severe cardiac toxicity. The matching factor was age. Multivariate Logistic regression was used to identify independent risk factors for severe cardiac toxicity.

A total of 128 patients were enrolled in this study. A median of six chemotherapy cycles were administered (range, 1-18 cycles). Cardiotoxicity was observed in 38 (29.7%) of 128 patients. 12 (9.4%) patients exhibited severe cardiac toxicity, and 2 (1.6%) patients died of cardiac toxicity. There was no difference in the incidence rate of cardiac toxicity or severe cardiac toxicity between fluorouracil treatments combined with taxanes or with platinum (P>0.05). The independent risk factors for severe cardiac toxicity identified by multivariable analysis were Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (OR=9.795, 95% CI: 1.283-74.772, P=0.028) and grade ≥ 3 neutropenia (OR=8.374, 95% CI: 1.183-59.279, P=0.033).

ECOG PS≥ 2 and grade≥ 3 neutropenia are independent risk factors for chemotherapy-related severe cardiotoxicity in patients with advanced gastric cancer. There is no significant difference in the incidence of cardiotoxicity between fuorouracil-based chemotherapy containing taxanes and that containing platinum.