Long‐Term Follow‐Up of Patients Undergoing Resection of TNM Stage I Colorectal Cancer: An Analysis of Tumour and Host Determinants of Outcome

Abstract

Screening for colorectal cancer improves cancer-specific survival (CSS) through the detection of early-stage disease; however, its impact on overall survival (OS) is unclear. The present study examined tumour and host determinants of outcome in TNM Stage I disease. All patients with pathologically confirmed TNM Stage I disease across 4 hospitals in the North of Glasgow between 2000 and 2008 were included. The preoperative modified Glasgow Prognostic Score (mGPS) was used as a marker of the host systemic inflammatory response (SIR). There were 191 patients identified, 105 (55%) were males, 91 (48%) were over the age of 75years and 7 (4%) patients underwent an emergency operation. In those with a preoperative CRP result (n=150), 35 (24%) patients had evidence of an elevated mGPS. Median follow-up of survivors was 116months (minimum 72months) during which 88 (46%) patients died; 7 (8%) had postoperative deaths, 15 (17%) had cancer-related deaths and 66 (75%) had non-cancer-related deaths. 5-year CSS was 95% and OS was 76%. On univariate analysis, advancing age (p<0.001), emergency presentation (p=0.008), and an elevated mGPS (p=0.012) were associated with reduced OS. On multivariate analysis, only age (HR=3.611, 95% CI 2.049-6.365, p<0.001) and the presence of an elevated mGPS (HR=2.173, 95% CI 1.204-3.921, p=0.010) retained significance. In patients undergoing resection for TNM Stage I colorectal cancer, an elevated mGPS was an objective independent marker of poorer OS. These patients may benefit from a targeted intervention.