Risk groups defined by Recursive Partitioning Analysis of patients with colorectal adenocarcinoma treated with colorectal resection

<p>Abstract</p> <p>Background</p> <p>To define different prognostic groups of surgical colorectal adenocarcinoma patients derived from recursive partitioning analysis (RPA).</p> <p>Methods</p> <p>Ten thousand four hundred ninety four patients with colorectal adenocarcinoma underwent colorectal resection from Taiwan Cancer Database during 2003 to 2005 were included in this study. Exclusion criteria included those patients with stage IV disease or without number information of lymph nodes. For the definition of risk groups, the method of classification and regression tree was performed. Main primary outcome was 5-year cancer-specific survival.</p> <p>Results</p> <p>We identified six prognostic factors for cancer-specific survival, resulting in seven terminal nodes. Four risk groups were defined as following: Group 1 (mild risk, 1,698 patients), Group 2 (moderate risk, 3,129 patients), Group 3 (high risk, 4,605 patients) and Group 4 (very high risk, 1,062 patients). The 5-year cancer-specific survival for Group 1, 2, 3, and 4 was 86.6%, 62.7%, 55.9%, and 36.6%, respectively (p < 0.001). Hazard ratio of death was 2.13, 5.52 and 10.56 (95% confidence interval 1.74-2.60, 4.58-6.66 and 8.66-12.9, respectively) times for Group 2, 3, and 4 as compared to Group 1. The predictive capability of these grouping was also similar in terms of overall and progression-free survival.</p> <p>Conclusion</p> <p>The use of RPA offered an alternative grouping method that could predict the survival of patients who underwent surgery for colorectal adenocarcinoma.</p

Analysis of Prognosis of 122 Colorectal Cancer Patients with Concurrent Liver Metastasis

OBJECTIVE To explore prognostic factors and treatment choices for colorectal cancer (CRC) patients with concurrent liver metastases (CLM). METHODS The data of the 122 CRC patients with CLM, who were treated in our hospital from January 2000 to December 2005, were collected. Overall survival rate of the patients in our group was analyzed using Kaplan-Meier method, and the univariate and multivariate analyses of the 18 factors aff ecting the survival rate, including clinicopathologic factors and treatment methods, were conducted using Log-rank test and Cox regression model (SPSS13.0). RESULTS The median survival time of the 122 patients with CRC was 13 months. The 1, 2, 3 and 5-year survival rate was 52.46%, 24.59%, 12.30% and 3.28%, respectively. Univariate analysis combined with Kaplan-Meier curve revealed that the factors of prognosis included the size of the primary tumor, the levels of differentiation, lymphatic status, cancerous ileus (CI), the number, size and distribution of liver metastases, extrahepatic involvement, the serum CEA level at diagnosis, treatment modality, the extent of primary resection, chemotherapeutic modality and regimen. Multivariate analysis showed that CI, differentiation levels, serum CEA value at diagnosis and treatment modality were the independent prognostic factors of CRC patients with CLM. CONCLUSION For the CRC patients with CLM, poor differentiation of the tumor and CI, as well as a high CEA level indicate an unfavorable prognosis. Treatment choice is of special significance in treating the CRC patients with CLM, so active radical excision of the primary tumor and liver metastasis is strongly recommended in the CRC patients with hepatic metastasis alone. Interventional chemotherapy has advantages compared with the whole-body chemotherapy via peripheral vein, and the regimen of systemic chemotherapy containing oxaliplatin is preferred

Prediagnostic plasma vitamin B6 (pyridoxal 5′-phosphate) and survival in patients with colorectal cancer

PURPOSE: Higher plasma pyridoxal 5′-phosphate (PLP) levels are associated with a decreased incidence of colorectal cancer, but the influence of plasma PLP on survival of patients with colorectal cancer is unknown. We prospectively examined whether prediagnostic plasma PLP levels are associated with mortality among colorectal cancer patients. METHODS: We included 472 incident cases of colorectal cancer identified in the Nurses’ Health Study, the Health Professionals Follow-up Study, and the Physicians’ Health Study from 1984 to 2002. The patients provided blood samples two or more years before cancer diagnosis. Stratified Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence interval (CI) adjusted for other risk factors for cancer survival. RESULTS: Higher plasma PLP levels were not associated with a significant reduction in colorectal cancer-specific (169 deaths) or overall mortality (259 deaths). Compared with patients who had less than 45 pmol/ml of plasma PLP (median: 33.6 pmol/ml), those who had 110 pmol/ml or higher levels (median: 158.8 pmol/ml) had multivariable HRs of 0.85 (95% CI 0.50–1.45, P trend = 0.37) and 0.87 (95% CI 0.56–1.35, P trend = 0.24) for colorectal cancer-specific and overall mortality. Higher plasma PLP levels, however, seemed to be associated with better survival among patients who had lower circulating 25-hydroxyvitamin D(3) levels(< 26.5 ng/ml) (P interaction ≤ .005). CONCLUSIONS: Higher prediagnostic plasma PLP levels were not associated with an improvement on colorectal cancer survival overall. Further research is needed to clarify the influence of vitamin B6 on colorectal cancer progression and survival