Associations of exposure to per- and polyfluoroalkyl substances mixture with the numbers of lymph nodes in colorectal cancer patients

Colorectal cancer (CRC) is widely known with a high incidence rate worldwide, but the correlation between exposure to per- and polyfluoroalkyl substances (PFAS) and the number of lymph nodes in CRC patients remains unclear. In the present study, we enrolled 305 CRC patients (122 females and 183 males) at Beijing Hospital in China. A total of 17 PFAS were detected in serum samples of these patients, and 5 PFAS with detection rates >75% were selected in this study. The CRC patients' number of metastatic lymph nodes (MLNs) and total lymph nodes (TLNs) were chosen as outcomes. Poisson regression models were used to analyze the associations between single PFAS and number of MLNs and TLNs. Quantile g-Computation models were performed to examine the joint effect of PFAS mixtures on number of MLNs and TLNs. A positive correlation between serum PFAS levels and number of MLNs was identified. For instance, the numbers of MLNs in patients with serum PFOA, PFNA, 6:2 Cl-PFESA concentrations at the 95th percentile were 27% (95% CI: 1%, 60%), 35% (95% CI: 1%, 82%), 87% (95% CI: 4%, 238%) higher compared with the threshold level. The results of Quantile g-Computation models also showed that every quantile increase in PFAS mixtures was associated with a 4.67%, (95% CI: 0.07%, 9.48%) increase in the numbers of MLNs, and PFOS dominated the effects of the mixtures. Moreover, a negative correlation between PFAS mixtures and number of TLNs in patients with no MLNs was also observed. The present study suggested that exposure to PFAS may worsen the prognosis of CRC patients. These findings could help guide future research and public health policies aimed at reducing exposure to PFAS and mitigating their potential impacts on human health.