Clinical presentation predicts the outcome of patients with colon cancer

Abstract

AIM:To elucidate the relationship between clinical presentation and outcome. METHODS:A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality. An odds ratio based clinical score was created to evaluate the contribution of the quality of symptoms to outcome. Primary measure of outcome was survival. RESULTS:During the study period, 236 patients met the inclusion criteria. Overall survival was 60.6%, mean follow-up 3.0 years. A bivariate analysis showed that increasing number of symptoms is not associated with mortality. However, a symptom-specific analysis performed using a logistic regression model controlling for age, stage and the duration of complaints revealed that the presence of melena was independently associated with mortality [P = 0.04, odds ratio (OR) 7.4], while rectal bleeding was associated with survival (P = 0.004, OR 3.9). Applying the proposed clinical score to an receiver operating characteristic curve showed that score > 1 had a strong association with mortality. The same logistic regression model was applied. The results showed that a score > 1 was an independent predictor of mortality (P < 0.001) and associated with nodepositive disease (P = 0.008). CONCLUSION:The quality of symptoms rather than quantity is correlated with outcome among patients with colon cancer. The proposed clinical scoring system may correctly predict the patient's outcome.

Colorectal cancer survival in Jamaica

“…It perhaps points to cultural differences where this finding is considered to reflect abnormal intestinal pathology that cannot be denied, hence it is more readily investigated, diagnosed and treated. This finding has been previously documented where the presence of rectal bleeding as a presenting complaint is positively associated with survival [10] . Other symptoms such as change in bowel habits or abdominal pain are perhaps more likely to be accommodated by the patients.…”

Clinicopathological profile of colorectal cancer managed at a university teaching hospital, Nepal

“…The noticed bleeding, change in bowel habit and weight loss occurred more in left than right colon. 15 However, in our analysis even though 55% of patients had PR bleeding, less than 19% had a mass per rectum in DRE. Our policy is to do at least sigmoidoscopy in all the patients with PR bleeding after exclusion of fissures even if DRE negative and proctoscopy revealing hemorrhoids.…”

A comprehensive study on colorectal malignancies

“…The finding was however consistent with Peedikayil et al 9,11,12 The common symptoms encountered among the subjects were altered bowel habits, abdominal palpable lump, abnormal digital rectal examination, anemia and intestinal obstruction. Similar findings were expressed by studies such as Sinha et al, Hamilton et al and Ben-Ishay et al [21][22][23] The major difference is the relatively higher proportion of patients presenting with acute abdominal obstruction. Metastasis was present in 10% of cases, in line with Sinha et al 21 Histological grading of the carcinomatous cells showed that most of the patients were in the grade II or moderately differentiated category.…”