Prognostic factors in colorectal cancers

Öz

Objective: The aim of this study is to investigate retrospectively the impact of the various prognostic factors on survival in patients with colorectal cancer. Methods: The clinical records, pathology and operation reports of 126 patients in 154 patients operated for colorectal cancer General Surgery Clinic of Fırat University Hospital between 1994 and 2005 years. The effects of the prognostic factors on 2-years, 5-years and 10-years survival, overall survival (OS) and disease-free survival (DFS) were evaluated. The survival durations are presented as months. Results: The mean age was 57.5 ± 15.2. The median duration of follow-up was 44,5 month. The median OS was 60 months. The median DFS in stage I-III patients was 62 months. According to the univariate analysis, the factors found significant in both OS and DFS rates were the following; stage of the cancer, extent of bowel wall penetration, lymph nodes metastasis, distant metastasis, pathologic stage, surgical margin, pretreatment CEA levels and type of surgery. The age and histologic type of tumor were related to only OS. The following variables were independent prognostic factors for both OS and DFS as determined by multivariate analysis; stage of the cancer, extent of bowel wall penetration and distant metastasis. Conclusion: A large number of prognostic factors are available to help predict the outcome of patients with colorectal cancer after surgery. In order to predict survival more accurately, a scoring system can be created that involving not only prognostic factors determined by multivariate analysis, but also prognostic factors determined by univariate analysis.

Anahtar Kelimeler

• Colorectal cancer, survival, prognostic factor

Kolorektal kanserlerde prognostik faktörler

Öz

Amaç: Bu çalışmadaki amacımız kolorektal kanserli hastalarımızda prognostik faktörlerin sağ kalım üzerine etkilerini retrospektif olarak incelemektir. Yöntemler: Fırat Üniversitesi Hastanesi Genel Cerrahi Kliniğinde 1994 ve 2005 yılları arasında kolorektal kanser tanısıyla cerrahi tedavi uygulanan 154 hasta içerisinden 126 hastanın klinik kayıtları, patoloji ve ameliyat raporları geriye dönük olarak incelendi. Hastalarda belirlenen prognostik faktörlerin 2 yıllık, 5 yıllık ve 10 yıllık sağ kalım, genel sağ kalım (GSK) ve hastalıksız sağ kalım (HSK) üzerine etkileri araştırıldı. Sağ kalım süreleri ay olarak hesaplandı. Bulgular: Hastaların 72 (%57,1)\'si erkek, 54 (%42,9)\'ü kadın olup yaş ortalaması 57,5 ± 15,2 idi. Ortanca takip süresi 44,5 ay idi. Hastalarda ortanca GSK 60 ay idi. 2,5 ve 10 yıllık GSK oranları sırasıyla %59,5, %46,0 ve %42,9 idi. Ortanca HSK evre I-III kanserli hastalarda 62 ay ve toplamda 40 ay olarak bulundu. Tek değişkenli analizde patolojik evre, kanserin evresi, T evresi, lenf nodu tutulumu, metastaz, cerrahi sınır, preoperatif CEA düzeyi ve uygulanan cerrahi tedavi hem GSK hem de HSK ile ilişkili bulundu. Yaş ve histolojik tip sadece GSK ile ilişkili bulundu. Çok değişkenli analizde kanserin evresi, T evresi ve metastaz GSK ve HSK açısından anlamlı bulunan bağımsız prognostik parametreler olarak değerlendirildi. Sonuç: Kolorektal kanserlerde cerrahi tedavi sonrası sağ kalımı etkileyen çok sayıda prognostik faktör mevcuttur. Sağ kalımı daha isabetli tahmin etmek amacıyla, bağımsız prognostik faktörlerin yanında, diğer prognostik faktörleri de içeren bir skorlama sistemi daha geniş serilerle oluşturulabilir.

Anahtar Kelimeler

• Kolorektal kanser, sağkalım, prognostik faktör

Kaynakça

1. Parkin DM, Bray F, Ferlay J, et al. Global Cancer statistics, 2002. CA J Clin 2005;55:74-108.
2. Townsend CM, Beauchamp RD, Evers BM. Modern Cerrahi Pratiğin Biyolojik Temeli. İlhan YS, Bülbüller N (Çeviren). s.1401-1481, İstanbul, Nobel Tıp Kitabevleri, 2010.
3. Welton ML, Varma MG, Amerhauser A. Colon, rectum and anus. Norton JA, Barie PS, Bollinger RR, Chang AE, Lowry S, Mulvihill SJ (Editors). Surgery: Basic science and clinical evidence. 1st Edition, New York: Springer, 2001:667-762.
4. Hermanek P, Gospodarowicz MK, Henson DE, et al. Interna- tional Union Against Cancer (IUCC): Prognostic factors in cancer. Berlin. Springer New York, 1995.
5. Sjo OH, Lunde OC, Nygaard K, et al. Tumor location is a prognostic factor for survival in colonic cancer patients. Colorectal Dis 2008; 10: 33–40.
6. Newland RC, Chapuis PH, Pheils MT, et al. The relationship of survival to staging and grading of colorectal carcinoma: A prospective study of 503 cases. Cancer 1981;47:1424- 1429.
7. Newland RC, Dent OF, Lyttle MN, et al. Pathologic deter- minants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 pa- tients. Cancer 1994;73:2076–2082.
8. Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al. Lymph node evaluation and survival after curative resection of co- lon cancer: systematic review. J Natl Cancer Inst 2007; 99: 433–441.

9. Moghimi Dehkordi B, Safaee A, Zali MR. Prognostic factors in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis 2008; 2008; 23: 683-688.
10. Mehrkhani F, Nasiri S, Donboli K, et al. Prognostic factors in survival of colorectal cancer patients after surgery. Co- lorectal Dis 2008; 11: 157–161.
11. Ruo L, Gougoutas C, Paty PB, et al. Elective bowel resec- tion for ıncurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 2003; 196:722–728.
12. Welsh FK, Tekkis PP, O’Rourke T, et al. Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: An aid to clinical decision-making. Surg Oncol 2008;17:3-13.
13. Küpelioğlu AA. Kolorektal kanserde histopatoloji. Turkiye Klinikleri J Surgery 2004;9:25-27.
14. Chen JS, Hsieh PS, Chiang JM, et al. Clinical outcome of signet ring cell carcinoma and mucinous adenocarcinoma of the colon. Chang Gung Med J 2010;33:51-57.
15. Gönen Ö. Kolorektal kanser epidemiyolojisi. T Klin J Sur- gery 2004;9:11-14.
16. Mitry E, Benhamiche AM, Jouve JL, et al. Colorectal ade- nocarcinoma in patients under 45 years of age: comparison with older patients in well-defined French population. Dis Colon Rectum 2001;44:380-387.
17. Elsaleh H, Joseph D, Grieu F, et al. Association of tumour site and sex with survival benefit from adjuvant chemo- therapy in colorectal cancer. Lancet 2000;355:1745-1750.
18. Wolmark N, Wieand HS, Rockette HE, et al. The prognos- tic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Findings from the NSABP clinical trials. Ann Surg 1983;198:743-752.
19. Xu FY, Di MJ, Dong JK, et al. Influence of clinical and pathomorphological parameters on prognosis in colon car- cinoma and rectal carcinoma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2006;35:303–310.
20. Park YJ, Park KJ, Park JG, et al. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutive- ly operated cases. World J Surg 1999;23:721-726.
21. Mulcahy HE, Skelly MM, Husain A, et al. Longterm out- come following curative surgery for malignant large bowel obstruction. Br J Surg 1996;83:46 –50.
22. Lehnert T, Methner M, Pollok A, et al. Multivisceral resec- tion for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002;235:217–225.
23. Hotta T, Takifuji K, Yokoyama S, et al. Survival in colorec- tal cancer patients with urinary tract ınvasion. Dis Colon Rectum 2006; 49: 1399-1409.
24. Kyllönen LE. Obstruction and perforation complicating colorectal carcinoma. Acta Chir Scand 1987;153:607–614.
25. Willet C, Tepper JE, Cohen A, et al. Obstructive and perfo- rative colonic carcinoma: Patterns of failure. J Clin Oncol 1985;3:379-384.
26. Compton C, Fenoglio-Preiser CM, Pettigrew N, et al. American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer 2000;88:1739-1757.
27. Harrison LE, Guillem JG, Paty P, et al. Preoperative carci- noembryonic antigen predicts outcomes in node-negative colon cancer patients: a multivariate analysis of 572 pa- tients. J Am Coll Surg 1997;185:55–59.
28. Petersen S, Freitag M, Hellmich G, et al. Anastomotic leak- age: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorect Dis 1998;13:160–163.
29. Akyol AM, McGregor JR, Galloway DJ, et al. Anastomotic leaks in colorectal cancer surgery: a risk factor for recur- rence? Int J Colorectal Dis 1991;6:179–183.
30. Bass AJ, Meyerhardt JA, Chan JA, et al. Family history and survival after colorectal cancer diagnosis. Cancer 2008;112: 1222–1229.
31. Slattery ML, Levin TR, Goldgar D, et al. Family history and colorectal cancer: predictors of risk. Cancer Causes Con- trol. 2003;14:879–887.
32. Bertario L, Russo A, Sala P, et al. Survival of patients with hereditary colorectal cancer: Comparison of HNPCC and colorectal cancer in FAP patients with sporadic colorectal cancer. Int J Cancer 1999;80:183–187.
33. Passman MA, Pommier RF, Vetto JT. Synchronous colon primaries have the same prognosis as solitary colon can- cers. Dis Colon Rectum 1996;39:329-334.
34. Oya M, Takahashi S, Okuyama T, et al. Synchronous colorectal carcinoma: clinico-pathological features and prognosis. Jpn J Clin Oncol 2003;33:38–43.
35. Nespoli A, Gianotti L, Totis M, et al. Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumor 2004;90:485-449.