Determinants of survival in a cohort of Costa Rican patients with colorectal cancer
DOI:
https://doi.org/10.51481/amc.v64i2.1183Keywords:
Colonic neoplasms, Costa Rica, mortality, prognosis, survivalAbstract
Aim: To identify prognostic variables of overall survival in a cohort of Costa Rican patients with colorectal adenocarcinoma who were treated at the San Juan de Dios Hospital between January 2010 and December 2015.
Methods: A retrospective cohort study was conducted with all patients diagnosed with colorectal adenocarcinoma during the study period. Clinical variables were obtained from medical records. Determinants of overall survival were identified by a Cox univariate and multivariate regression analysis, with its respective hazard ratio (HR) and 95% confidence interval (IC 95%).
Results: A total of 667 patients were included in this study. Median follow-up was 25.4 months. Five-year survival according to clinical stage was 91.7%, 60%, 44.9% and 18.9% for stages I, II, III, and IV, respectively. In the univariate analysis, age greater than 65 years, tumor grade, advanced clinical stage, poor performance status, proximal location of the primary tumor, a high index of positive nodes and negative retrieved nodes, and the absence of microsatelital instability were statistically associated to death. However, after adjustment for potential confounders, only the performance status at the beginning of treatment (HR: 3.06; IC 95%: 1.65-5.69; p<0.001 for the comparison of ECOG 0 vs 1 and 2.) and age older than 65 years (HR: 1.64, IC 95%: 1.10-2.43; p=0.014) were independently associated with overall survival.
Conclusion: Functional status at the time of diagnosis and clinical stage were the independent variables associated to survival in the studied cohort.
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Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683-691. DOI: 10.1136/gutjnl-2015-310912
Purim O, Gordon N, Brenner B. Cancer of the colon and rectum: potential effects of sex-age interactions on incidence and outcome. Med Sci Monit. 2013;19:203-209. DOI: 10.12659/MSM.883842
Sierra MS, Forman D. Burden of colorectal cancer in Central and South America. Cancer Epidemiol. 2016;44:S74-S81. DOI: 10.1016/j.canep.2016.03.010
Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RG, Barzi A, et al. Colorectal cancer statistics, 2017. CA: Cancer J Clin. 2017;67:177-193. DOI: 10.3322/caac.21395.
Petrelli F, Tomasello G, Borgonovo K, Ghidni M, Turati L, Dallera P, et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol. 2017;3:211-219. DOI: 10.1001/jamaoncol.2016.4227.
Lee GH, Malietzis G, Askari A, Bernardo D, Al-Hassi HO, Clark SK. Is right-sided colon cancer different to left-sided colorectal cancer? A systematic review. Eur J Surg Oncol. 2015;41:300-308. DOI: 10.1016/j.ejso.2014.11.001.
van Leeuwen BL, Páhlman L, Gunnarsson U, Sjövall A, Martling A. The effect of age and gender on outcome after treatment for colon carcinoma. A population-based study in the Uppsala and Stockholm region. Crit Rev Oncol Hematol. 2008;67:229-236. DOI: 10.1016/j.critrevonc.2008.03.005.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: Cancer J Clin. 2018;68:7-30. DOI: 10.3322/caac.21442.
Schiffmann l, Ózcan S, Schwarz F, Lange J, Prall F, Klar E. Colorectal cancer in the elderly—surgical treatment and long-term survival. Int J Colorectal Dis. 2008;23:601-610. DOI: 10.1007/s00384-008-0457-5.
Maisey NR, Norman A, Watson M, Allen MJ, Hill ME, Cunningham D. Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer. 2002;38:1351-1357. DOI: 10.1016/s0959-8049(02)00098-9.
Jang RW, Caraiscos VB, Swami N, Banerjee S, Mark E, Kaya E, et al. Simple prognostic model for patients with advanced cancer based on performance status. J Oncol Pract. 2014;10: 335-e341. DOI: 10.1200/JOP.2014.001457.
Fleming M, Ravula S, Tatishchev S, Wang HL. Colorrectal carcinoma: Pathologic aspects. J Gastrointest Oncol. 2012;3:153-173. DOI: 10.3978/j.issn.2078-6891.2012.030.
Melis M, Hernandez J, Siegel EM, McLoughlin JM, Ly QP, Nair RM, et al. Gene expression profiling of colorectal mucinous adenocarcinomas. Dis Colon Rectum. 2010;53:936-943. DOI: 10.1007/DCR.0b013e3181d320c4.
André T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004; 50:2343-2351. DOI: 10.1056/NEJMoa032709
QUASAR Collaborative Group. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet. 2007;370:2020-2029. DOI: 10.1016/S0140-6736(07)61866-2.
Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Tangen CM, et al. Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med. 1995;122:321-326. DOI: 10.7326/0003-4819-122-5-199503010-00001.
André T, de Gramont A, Vernerey D, Chibaudel B, Bonnetain F, Tijeras-Raballand A, et al. Adjuvant fluorouracil, leucovorin, and oxaliplatin in stage II to III colon cancer: updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study. J Clin Oncol. 2015;33:4176-4187. DOI: 10.1200/JCO.2015.63.4238.
Berglund A, Cedermark B, Glimelius B. Is it deleterious to delay the start of adjuvant chemotherapy in colon cancer stage III? Ann Oncol. 2008;19:400-402. DOI: 10.1093/annonc/mdm582.
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