Long-term follow-up of patients undergoing resection of tnm stage i colorectal cancer: an analysis of tumour and host determinants of outcome

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Mansouri, David ; Powell, Arfon ; Park, James H. ; McMillan, Donald C. ; Horgan, Paul G. (2016)

Background\ud \ud 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.\ud \ud Methods\ud \ud 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).\ud \ud Results\ud \ud There were 191 patients identified, 105 (55 %) were males, 91 (48 %) were over the age of 75 years 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 116 months (minimum 72 months) 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.\ud \ud Conclusions\ud \ud 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.
  • References (17)
    17 references, page 1 of 2

    Kronborg O, Fenger C, Olsen J, et al (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348:1467-1471.

    Hardcastle JD, Chamberlain JO, Robinson MH, et al (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348:1472-1477.

    Mandel JS, Bond JH, Church TR, et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328:1365-1371.

    Nicholson GA, Finlay IG, Diament RH, et al (2011) Mechanical bowel preparation does not influence outcomes following colonic cancer resection.

    Br J Surg 98:866-871.

    Roxburgh C, McTaggart F, Balsitis M, et al (2013) The impact of the bowel screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran. Colorectal Dis 15:34-41 Logan RF, Patnick J, Nickerson C, et al (2012) Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests.

    Gut 61:1439-1446.

    UK Colorectal Cancer Screening Pilot Group (2004) Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom. BMJ 329:133.

    Mansouri D, McMillan DC, Grant Y at al (2013) The impact of age, sex and socioeconomic deprivation on outcomes in a colorectal cancer screening programme. PloS one 8:e66063.

    26. Crozier JE, Leitch EF, McKee RF, et al (2009) Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Am J Surg 197:544-549.

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