Abstract
The clinical, laboratory, and pathologic data of 310 patients who had curative resections were prospectively collected and analyzed in a multiple step wise regression model. Although several factors (i.e., venous invasion) were of importance in univariate analysis, the following conclusions reflect the outcome and relative importance of the regression analysis only. Blood loss as an initial symptom and duration of symptoms were associated with a better prognosis. Location of the primary tumor, age, and sex did not appear to have prognostic value. Observations during operation such as palpable lymph nodes, fixity to adjacent organs, and tumor spill were related to a diminished tumor-free survival. Laboratory data (hemoglobin, leukocytes, ESR, GGTP, SGOT, SGPT, LDH, total protein, CEA) were tested for their potential prognostic values. Only a preoperative low protein level or an elevated CEA level were associated with an increased risk of death due to recurrent tumor. The histopathologic features (stage and grade), with the exception of venous invasion, were of relative importance in the determination of prognosis. The aforementioned variables can be included in a prognostic index on the base of which high-risk groups suitable for adjuvant studies can be identified.
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References
Spratt JS, Spjut HJ. Prevalence and prognosis of individual clinical and pathological variables associated with colorectal carcinoma. Cancer 1967;20:1976–85.
Cox DR, Oakes D. Analysis of survival data. London: Chapman and Hall, 1984.
Wiggers T, Jeekel J, Arends JW, et al. The no-touch isolation technique in colon cancer: a prospective controlled multicentre trial. Br J Surg 1985;72 suppl:S135.
Turnbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 1967;166:420–7.
Blenkinsopp WK, Stewart-Brown S, Blesovsky L, Kearney G, Fielding LP, Histopathology reporting in large bowel cancer. J Clin Pathol 1981;34:509–13.
BMDP Statistical Software. Dept. of Biomathematics, University of California, Berkeley: University of California Press, 1981.
Mzabi R, Himal HS, Demers R, MacLean LD. A multiparametric computer analysis of carcinoma of the colon. Surg Gynecol Obstet 1976;143:959–64.
Kim U, Papatestas AE, Aufses AH. Factors influencing survival of colorectal cancer. Mt Sinai J Med 1978;45:210–14.
Chapuis PH, Dent OF, Fisher R, et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg 1985;72:698–702.
Steinberg SM, Barkin JS, Kaplan RS, Stablein DM. Prognostic indicators of colon tumors: the gastrointestinal study group experience. Cancer 1986;57:1866–70.
Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg 1985;72:296–302.
McDermott FT, Hughes ES, Pihl E, Milne BJ, Price AB. Prognosis in relation to symptom duration in colon cancer. Br J Surg 1981;68:846–49.
Pescatori M, Maria G, Beltrani G, Mattana C. Site, emergency, and duration of symptoms in the prognosis of colorectal cancer. Dis Colon Rectum 1982;25:33–40.
Stubbs RS, Long MG. Symptom duration and pathologic staging of colorectal cancer. Eur J Surg Oncol 1986;12:127–30.
Polissar L, Sim D, Phil M, Francis A. Survival of colorectal cancer patients in relation to duration of symptoms and other prognostic factors. Dis Colon Rectum 1981;24:364–9.
Khubchandani M. Relationship of symptom duration and survival in patients with carcinoma of the colon and rectum. Dis Colon Rectum 1985;28:585–7.
Wied U, Nilsson T, Knudsen JB, Sprechler M, Johansen AA. Postoperative survival of patients with potentially curable cancer of the colon. Dis Colon Rectum 1985;28:333–5.
Tartter PI, Slater G, Papatestas AE, Aufses AH. The prognostic significance of elevated serum alkaline phosphatase levels preoperatively in patients with carcinoma of the colon and rectum. Surg Gynecol Obstet 1984;158:569–71.
Wanebo HJ, Rao B, Pinsky CM, et al. Pre-operative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. N Engl J Med 1978;299:448–51.
Staab HJ, Anderer FA, Brümmendorf T, Stumph E, Fischer R. Prognostic value of preoperative serum CEA level compared to clinical staging. I. Colorectal carcinoma. Br J Cancer 1981;44:652–62.
Wolmark N, Fisher B, Wieand HS, et al. The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer. Ann Surg 1984;199:375–81.
Olson RM, Perencevich NP, Malcolm AW, Chaffey JT, Wilson RE. Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum. Cancer 1980;45:2969–74.
Kelley WE, Brown PW, Lawrence W, Terz JJ. Penetrating, obstructing and perforating carcinomas of the colon and rectum. Arch Surg 1981;116:381–4.
Habib NA, Peck MA, Sawyer CN, Blaxland JW, Luck RJ. Does fixity affect prognosis in colorectal tumours? Br J Surg 1983;70:423–4.
Umpleby HC, Bristol JB, Rainey JB, Williamson RC. Survival of 727 patients with single carcinomas of the large bowel. Dis Colon Rectum 1984;27:803–10.
Ranbarger KR, Johnston WD, Chang JC. Prognostic significance of surgical perforation of the rectum during abdominoperineal resection for rectal carcinoma. Am J Surg 1982;143:186–8.
Slantz CA Jr. The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 1984;27:792–7.
Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Large bowel cancer: survival pathology and its relationship to survival. Br J Surg 1984;71:604–10.
Jass JR, Atkin WS, Cuzick J, et al. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology 1986;10:437–59.
Nowacki MP, Szymendera JJ. The strongest prognostic factors in colorectal carcinoma: surgicopathologic stage of disease and postoperative fever. Dis Colon Rectum 1983;26:263–8.
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Wiggers, T., Arends, J.W. & Volovics, A. Regression analysis of prognostic factors in colorectal cancer after curative resections. Dis Colon Rectum 31, 33–41 (1988). https://doi.org/10.1007/BF02552567
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DOI: https://doi.org/10.1007/BF02552567