Abstract
Stage III colon cancer patients demonstrate diverse clinical outcomes. The aim of this study was to develop a prognostic model in order to better predict their survival. From 2004 to 2010, 548 patients were retrospectively analyzed, among whom 328 were defined as the study group and the remaining 220 served as a validation group. Clinico-pathologic features, including age, gender, histological grade, T stage, number of positive lymph nodes, number of harvest lymph nodes, pretreatment carcinoembryonic antigen (CEA) levels and pretreatment neutrophil lymphocyte ratio (NLR), were collected. Kaplan-Meier survival curves were used to detect prognostic factors and multivariate analysis was applied to identify independent examples on which to develop a prognostic model. Finally, the model was further validated with the validation group. Histological grade (p=0.002), T stage (p=0.011), number of positive lymph nodes (p=0.003), number of harvested lymph nodes (p=0.020), CEA (p=0.005), and NLR (p<0.001) were found as prognostic factors while histological grade [RR(relative risk):0.632, 95%CI (Confidence interval) 0.405~0.985, p=0.043], CEA (RR:0.644, 95%CI:0.431~0.964, p=0.033) and NLR (RR:0.384, 95%CI:0.255~0.580, p<0.001) levels were independent. The prognostic model based on these three factors was able to classify patients into high risk, intermediate and low risk groups (p<0.001), both in study and validation groups. Histological grade, pretreatment CEA and NLR levels are independent prognostic factors in stage III colon cancer patients. A prognostic model based on these factors merits attention in future clinical practice.
Highlights
With approximate one million new cases every year (Barton, 2012), colon cancer is one of the most severe health burdens all over the world
Histological grade (p=0.002), T stage (p=0.011), number of positive lymph nodes (p=0.003), number of harvested lymph nodes (p=0.020), carcinoembryonic antigen (CEA) (p=0.005), and neutrophil lymphocyte ratio (NLR) (p
The exclusion criteria were 1) patients who accepted emerging surgery; 2) patients who died within three months after surgery; 3) patients who were with a positive surgical margin; 4) patients who accepted chemotherapy before surgery. 548 patients were involved in this study, among which 328, which were selected from The Affiliated Hospital of Hainan Medical College, were defined as study group, and 220 which were selected from Sun Yat-sen University Cancer Center were defined as validation group
Summary
With approximate one million new cases every year (Barton, 2012), colon cancer is one of the most severe health burdens all over the world. Far from a homogeneous patients group, patients with stage III colon cancer harbor subgroups with notably diverse clinical outcomes- since the five year survival rate ranges from 44% to 83% (Wong et al., 2011). What’s more, a considerable amount of patients may remain recurrence free even without adjuvant chemotherapy (Wong et al, 2011), as reported by Adlard et al (2002) that approximate 60% stage III colon cancer patients cannot get benefit from adjuvant treatment. Stage III colon cancer patients demonstrate diverse clinical outcomes. The prognostic model based on these three factors was able to classify patients into high risk, intermediate and low risk groups (p
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