Novel prognostic prediction models for patients with stage IV colorectal cancer after concurrent curative resection

Abstract

BackgroundWe developed a prediction tool for recurrence and survival in patients with stage IV colorectal cancer (CRC) following surgically curative resection.Patients and methodsFrom January 1983 to December 2012, 113 patients with CRC and synchronous liver and/or lung metastatic CRC were investigated at the Osaka Medical Center for Cancer and Cardiovascular Diseases. All patients underwent curative resection of primary and metastatic lesions. In the group of patients who underwent surgery from 1983 to 2008, a Cox regression model was used to develop prediction models for 1-year, 3-year and 5-year cancer-specific survival (CSS) and relapse-free survival (RFS). In the other group of patients who underwent surgery from 2009 to 2012, the developed prediction model was validated.ResultsUnivariate analysis of clinicopathological factors showed that the following factors were significantly correlated with CSS and RFS: preoperative serum carcinoembryonic antigen level, tumour location, pathologically defined tumour invasion and lymph node metastasis, and synchronous metastatic lesions. Using these variables, novel prediction models predicting CSS and RFS were constructed using the Cox regression model with concordance indexes of 0.802 for CSS and 0.631 for RFS. The prediction models were validated by external data sets in an independent patient group.ConclusionsWe developed novel and reliable personalised prognostic models, integrating tumour, node, metastasis (TNM) factors as well as the preoperative serum carcinoembryonic antigen level, tumour location and metastatic lesions, to predict patients' prognosis following surgically curative resection. This individualised prediction model may help clinicians in the treatment of postoperative stage IV CRC following surgically curative resection.

Primary tumor resection in stage IV unresectable colorectal cancer: what has changed?

“…There is a need for advanced prediction tools that would assist multidisciplinary teams in reaching treatment consensus. Previously, predictive models that have been created focused on hepatic resection for metastatic colorectal cancer [ 49 – 51 ], and only recently a model for predicting recurrence and survival in patients undergoing concurrent curative resection has been described [ 52 ]. Another aspect that might lead us into personalized, predictive medicine is utilizing knowledge about gene mutations, metabolic pathways and their impact on colorectal cancer development [ 53 ].…”

Prognostic and predictive values of tumour budding in stage IV colorectal cancer

“…Several studies [20][21][22][23][24][25][26][27][28] have reported that the TNM classification has significant prognostic value for stage IV colorectal cancer. Specifically, the type, number and spread of metastatic organs affect the prognosis of patients with stage IV disease.…”

Comparison between High andLow Binding of the InferiorMesenteric Artery inMesorectal Excision of Rectal Tumor

“…Having the TNM staging, the accurate staging is an important as it can assess the outcomes of colorectal tumor [28][29][30][31] . Furthermore, the number of dissected lymph nodes can be used for the assessment of the success of the surgery.…”