Assessment of the Importance of Non-Stage Related Factors in the Prognosis of Resected Colorectal Cancer

Abstract

Objective: To assess the importance of clinical and histopathological features in the risk stratification of resected colorectal cancer and their utility as indicators of the need for adjuvant therapy.Methods: Prospectively collected data was analysed from 524 consecutive cases of colon and rectal cancer resected by a single surgical team with a median follow up of 49 months. Multivariate analysis was used to determine clinical and pathological features that independently predicted cancer related death and their relative importance.Results: Pathological features associated with an increased risk of cancer related death were the presence of metastatic disease, penetration of the bowel wall, lymph node status, perineural invasion and vascular invasion. Emergent surgery was the only clinical feature to predict cancer related death. Adjuvant chemotherapy significantly improved the survival of colorectal cancer patients whose tumours demonstrated either vascular or perineural invasion.Conclusions: Vascular and perineural invasion and emergent surgery are independent and significant predictors of death from colorectal cancer. Adjuvant chemotherapy improved the survival of patients whose tumours demonstrated vascular or perineural invasion. The components of TNM stage alone do not provide enough information on which to make decisions on the utility of adjuvant chemotherapy.