Predictors of survival in stage iv metastatic colorectal cancer


Patients. The medical records of 541 patients, with histologically proven metastatic CRC (UICC stage IV) between 1998 and 2008 were

retrospectively reviewed. All were consecutive non-selected cases from one center and all sorts of patients were treated outdoors

of numerous studies. No patients were candidates for surgical procedure (either curative or palliative), however, all received

palliative chemotherapy. Records with complete date (for that parameters utilized as prognostic factors) were incorporated within the analysis.

Single-agent chemotherapy regimens were according to leucovorin modulated 5-FU (Mayo clinic or AIO regimens). Combination chemotherapy

regimens incorporated combination treatments of 5-FU (DeGrammont or simple infusion and leucovorin) with either oxaliplatin or

irinotecan, or capecitabine without or with bevacizumab or cetuximab. Patients were monitored periodically for clinical and

laboratory proof of toxicity.

Prognostic variables. As many as 37 patient-related factors, tumor-related factors and complications associated with either disease progression or treatment

were joined within the analysis according to factors recognized by previous studies (9, 10), in addition to our very own clinical experience. Patient-related factors incorporated age (≤60 years or >60 years), gender and gratifaction

status (PS) based on the Karnofsky Performance Status Scale Index. Tumor-related factors incorporated signs and symptoms: fever (yes

versus. no), discomfort (yes versus. no) location of metastases: lymph nodes (yes versus. no), liver (yes versus. no), lung (yes versus. no), abdomen/peritoneum (yes versus. no), pelvis (yes versus. no), local recurrence (yes versus. no), bone (yes versus. no), skin (yes versus. no), adrenals (yes versus. no) and biochemical parameters. For that latter, group categorizations were utilised: for carcinoembryonic antigen (CEA): normal

≤5 mg/dl and elevated >5 mg/dl for cancer antigen 19-9 (CA 19-9): values ≤30 × normal (NL) versus. >30 × NL for C reactive protein (CRP): normal 15 mg/dl. Factors

associated with either reaction to treatment or disease progression incorporated chemotherapy (single agent versus. combination chemotherapy), alternation in PS (no change, improved, worse) and hematological complications. For that latter, group

categorizations were utilised: for neutropenia: white-colored bloodstream cell count >4000/μl, 2000-4000/μl, <2000/μl for anemia: hemoglobin

13.5 g% for thrombocytopenia: yes, platelets (PLT) ≤100,000/μl vs. no, PLT>100,000/μl. Additional factors incorporated nausea-vomiting (yes versus. no), diarrhea (absent, frequent, continuous problem), anorexia (absent, frequent, continuous problem), weight reduction ≥10% (yes

versus. no), mucositis (absent, frequent, continuous problem), fatigue (absent, frequent, continuous problem), nerve complications

(yes versus. no), mental complications (yes versus. no), alopecia (yes versus. no), hands and feet syndrome (yes versus. no), dermatological complications (yes versus. no), liver toxicity (yes versus. no), utilization of epoetin (yes versus. no), bloodstream transfusions (yes versus. no) and hypoalbuminemia (yes versus. no).

Record analysis. Descriptive statistics were calculated by using mean, median and standard deviation for quantitative measurements

and counts/percentages for discrete factors. Overall survival was understood to be time from the very first day of proper diagnosis of metastatic

CRC disease to dying associated with a cause, in order to the final follow-up examination. Survival data were studied by using Kaplan-Meier

method. Alterations in survival between groups were recorded using the log-rank test. Furthermore, Wald statistics were implemented

for bivariate associations between survival and quantitative measures for example age. A multivariate Cox regression model was

implemented for study regarding the parallel aftereffect of remaining parameters on survival. Best model selection took it’s origin from automated

techniques. Regression outcome was displayed by means of regression estimates tables. Hazard ratios of outcomes under

study were calculated for every parameter estimate in addition to 95% confidence times. Categorical covariates were compared

having a predefined reference category group. All analyses were conducted in a predefined significance degree of 5% using the

utilization of record package SPSS 12..


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