Clinical Predictors of Early Mortality in Colorectal Cancer Patients Undergoing Chemotherapy: Results From a Global Prospective Cohort Study

Abstract

Background Early mortality is a major problem in colorectal cancer (CRC). We have shown that Khorana Score is predictive of early mortality in other cancers. Here, we evaluated the value of this score and other prognostic variables in predicting early mortality in CRC. Methods CANTARISK was a prospective, noninterventional, global cohort study in patients with CRC initiating a new chemotherapy regimen. Data were collected at zero, two, four, and six months. Early mortality was defined as death within six months of enrollment. All data were compiled centrally and analyzed after the study closed. Statistically significant univariate associations were tested in multivariable models; adjusted odds ratios (ORs) are presented. Statistical tests were two-sided. Results From 2011 to 2012, 1789 CRC patients were enrolled. The median age was 62 years; 71% were Caucasian. One-third (35%) had a rectal primary, and 65% had metastatic disease. There were 184 (10.3%) patients who died during their first six months in the study. For low, intermediate, and high Khorana Score, there were 8.1%, 11.2% and 32.5% deaths, respectively. In multivariable analyses, Khorana Score was an independent predictor of early death (OR for high/intermediate vs low score = 1.70, P = .0027), in addition to age (OR for each incremental year = 1.03, P = .0014), presence of metastatic disease (OR = 3.28, P < .0001), and Easter Cooperative Oncology Group Performance Status Score of 2 or higher (OR = 3.85, P < .0001). Conclusions This study demonstrates that Khorana Score is predictive of early mortality in CRC patients. Intermediate- or high-risk patients, as defined by this score, may benefit from additional interventions aimed at reducing early mortality.

Association between the Khorana risk score and all-cause mortality in Japanese patients with gastric and colorectal cancer: A retrospective cohort study

“…The findings pointed to the presence of an independent predictive relationship between baseline KRS before chemotherapy and death within 2 years in patients with GC and CRC. This result is comparable to a global prospective study by Sohal et al [ 7 ], which observed that KRS predicted mortality within 6 mo in patients with CRC treated using chemotherapy. Moreover, similar findings have been reported for different tumor types in studies by Shibata et al [ 10 ], Kuderer et al [ 11 ], Mansfield et al [ 12 ], and Vathiotis et al [ 13 ].…”

“…Nevertheless, a 2018 systematic review observed that the score exhibited poor predictive power for individual tumor types, and unexpectedly, higher scores were associated with a higher risk of early death[ 5 ]. Some prospective studies have demonstrated its ability to predict early death in lung and colorectal cancers[ 6 , 7 ]. However, studies on the relationship between KRS and all-cause mortality are limited.…”

Healthcare costs of patients with cancer stratified by Khorana score risk levels

“…In the current study, both all-cause and VTE-related healthcare costs significantly increased with KS. All-cause healthcare costs were predominantly driven by non-VTE-related costs across all KS cohorts in the current study, which aligns with previous studies that have found KS to be predictive of early mortality and cancer progression during the first four cycles of outpatient chemotherapy, independent from other major prognostic factors including VTE itself [32][33][34].…”

“…Patients with cancer at high risk of VTE may incur higher healthcare costs than those at lower risk due to increased risk of early mortality and cancer progression [32][33][34], along with greater burden of VTE-related expenses and ensuing complications, including VTE recurrences, postthrombotic syndrome, and pulmonary hypertension [35]. However, among studies that assessed the economic burden of cancer-associated VTE, none stratified patients into different VTE risk cohorts.…”

Role of Ki67 protein in colorectal cancer

“…In 2013, there was 1.6 millions incidents of colorectal cancer and 771 000 deaths. 8 Moreover, the incident number shows a significant rise. Surgery with combination of adjuvant radiochemotherapy are the main treatment of colorectal cancer.…”