Prognostic factors for overall survival in metastatic colorectal cancer using a stop-and-go FLIRI-based treatment strategy.

Abstract

To determine overall survival and baseline prognostic variables in a cohort of patients with metastatic colorectal cancer receiving a FLIRI-based stop-and-go treatment strategy. Clinical information was collected from patient files in consecutive patients treated with palliative combination chemotherapy using a stop-and-go strategy from September 2007 until June 2011. The primary outcome was overall survival. Cox regression analysis was used to examine the effect of prognostic variables on survival. Baseline variables were performance status, primary tumor site, status of primary tumor (resected or unresected), synchronous metastases, >1 metastatic site, liver-only metastases, alkaline phosphatase (>300U/l), lactate dehydrogenase (>300U/l), platelets (>400 × 10(9)/l), and leucocytes (>10 × 10(9)/l). We included 314 patients (median age 64.5 (57-70) years). Median overall survival was 20.9 (95% confidence interval (CI), 19.1-223.4) months with a median follow-up of 21.3months (interquartile range (IQR) 13-34.8). Independent prognostic markers of decreased survival were PS 1 and 2 vs. 0 hazard ratio (HR) 1.47 (95% CI 1.14-1.91, p = 0.003) and HR 2.06 (95% CI 1.19-3.56, p = 0.01), colon as the primary tumor site HR 1.43 (95% CI 1.09-1.88, p = 0.009), unresected primary tumor HR 2.22 (95% CI 1.61-3.07, p < 0.001), and elevated leucocytes (>10 × 10(9)/l) HR 1.53 (95% CI 1.12-2.09, p = 0.007). Overall survival in metastatic colorectal cancer using a FLIRI-based stop-and-go strategy in an unselected consecutive cohort proved comparable to RCTs from the same period. Baseline prognostic markers of poorer prognosis were PS 1 or 2, colon as primary tumor site, unresected primary tumor, and leucocytes >10 × 10(9)/l. These variables are all easy accessible in daily clinical practice.