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<p>Previous studies have investigated association between metal exposure and colorectal cancer (CRC) and mainly focus on individual heavy metal or a limited combination of heavy metals. The potential effects of heavy metal mixture, as well as the joint influence of metals and per- and polyfluoroalkyl substances (PFAS) in blood on CRC prognosis remain insufficiently understood. The present study aims to identify the association of co-exposure to heavy metals and PFAS mixtures in blood samples from CRC patients. This cross-sectional study analyzed 309 plasma samples from CRC patients to measure 14 heavy metals and integrated serum PFAS data from a prior cohort. Copper and selenium levels in plasma exhibited a positive correlation with age and demonstrated statistically significant gender-based differences (Mann-Whitney U; <i>P</i> &lt; 0.01). Poisson regression analysis revealed that underweight CRC patients had higher selenium exposure compared to those with a normal body mass index (95% CI: 1.67 − 1.84; <i>P</i> &lt; 0.01). Neutrophil-to-lymphocyte ratio (NLR), metastatic lymph nodes, and the ratio of the number of metastatic lymph nodes to the total lymph nodes, were selected as outcomes for assessing the prognosis of CRC. Single-metal analysis suggested that heavy metals (such as copper and zinc) levels may be linked to CRC prognosis, with accompanying changes in inflammatory responses (e.g., NLR), and mixed PFAS exposure further pointed to a potential role of inflammation. Co-exposure to multiple environmental pollutants could be associated with CRC prognosis, but this hypothesis requires further investigation before any causal or adverse effects can be established.</p>

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Associations of Co-exposure to Heavy Metals and Per- and Polyfluoroalkyl Substances Mixtures with Medical Indicators in Colorectal Cancer Patients

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Meng-Yi Xie,
  • Wenxin Ouyang,
  • Jian Cui,
  • Jinxin Shi,
  • Qi An,
  • Lei Mai

摘要

Previous studies have investigated association between metal exposure and colorectal cancer (CRC) and mainly focus on individual heavy metal or a limited combination of heavy metals. The potential effects of heavy metal mixture, as well as the joint influence of metals and per- and polyfluoroalkyl substances (PFAS) in blood on CRC prognosis remain insufficiently understood. The present study aims to identify the association of co-exposure to heavy metals and PFAS mixtures in blood samples from CRC patients. This cross-sectional study analyzed 309 plasma samples from CRC patients to measure 14 heavy metals and integrated serum PFAS data from a prior cohort. Copper and selenium levels in plasma exhibited a positive correlation with age and demonstrated statistically significant gender-based differences (Mann-Whitney U; P < 0.01). Poisson regression analysis revealed that underweight CRC patients had higher selenium exposure compared to those with a normal body mass index (95% CI: 1.67 − 1.84; P < 0.01). Neutrophil-to-lymphocyte ratio (NLR), metastatic lymph nodes, and the ratio of the number of metastatic lymph nodes to the total lymph nodes, were selected as outcomes for assessing the prognosis of CRC. Single-metal analysis suggested that heavy metals (such as copper and zinc) levels may be linked to CRC prognosis, with accompanying changes in inflammatory responses (e.g., NLR), and mixed PFAS exposure further pointed to a potential role of inflammation. Co-exposure to multiple environmental pollutants could be associated with CRC prognosis, but this hypothesis requires further investigation before any causal or adverse effects can be established.