Postoperative hyperphosphatemia significantly associates with adverse survival in colorectal cancer patients

Abstract

Background Hyperphosphatemia has been implicated in the development and treatment of various cancers. However, whether it can be used as a direct prognostic marker of colorectal cancer (CRC) has remained unexplored. Given new insights into the importance of hyperphosphatemia in CRC, we sought to evaluate the association of hyperphosphatemia with the clinical outcomes of this disease. Methods In a retrospective analysis of a well-characterized clinic-based cohort with 1,241 CRC patients, we assessed the association of postoperative hyperphosphatemia with patient overall survival. Results Postoperative hyperphosphatemia measured within the first month after surgery was significantly associated with CRC survival. Compared to patients with a normal phosphate level, those with hyperphosphatemia exhibited a significant unfavorable overall survival with a hazard ratio (HR) of 1.84 (95% confidence interval [CI] 1.49–2.29, P=2.6×10−8, (log-rank P=1.2×10−7). Stratified analyses indicated the association was more pronounced in patients with colon (HR=2.00, 95% CI 1.57–2.56, P=3.17×10−8) but not rectal cancer (HR=0.96, 95% CI 0.58–1.59, P=0.889) (P interaction=0.023), as well as in those not receiving chemotherapy (HR=2.15, 95% CI 1.59–2.90, P=6.2×10−7) but not in those receiving chemotherapy (HR=1.30, 95% CI 0.92–1.82, P=0.136) (P interaction=0.012). Flexible parametric survival model demonstrated that the increased risk for death conferred by postoperative hyperphosphatemia persisted over 150 months after surgery. Conclusion Our data indicated that postoperative hyperphosphatemia might be used as a prognostic marker of CRC patients after surgery. Since phosphate level is routinely tested in clinics, it may be incorporated into clinical models to predict CRC survival.

Impact of Perioperative Phosphorus and Glucose Levels on Liver Regeneration and Long-term Outcomes after Major Liver Resection

“…32 In contrast, Ye and colleagues in their recent report of patients undergoing surgery for colorectal cancer demonstrated postoperative hyperphosphatemia to be associated with poor long-term clinical outcomes. 33 Of note, these authors suggested that the impact of hyperphosphatemia was relative to a wide inhibitory effect on signaling transductions protein kinase-mediated signaling pathways in the whole body and not restricted only to CRC-specific mechanisms. In the current study, although no correlation between serum phosphorus and postoperative morbidity was observed, patients who developed hyperphosphatemia on the second postoperative day had a worse long-term survival (Fig.…”

Changes of erythrocyte element status of colectomysed cancerous patients: Retrospective study

“…The significantly higher P level in cancerous patients compared to the other two groups maybe the sign of cell death, because hyperphosphatemia is also a signal of the rare but life threatening case, the tumor lysis syndrome (Kim 2014). The importance of P concentration is discussed in surgical cases, and in the future may become a crucial prognostic factor (Ye 2013). Zn concentration has changed diversely in the two patient groups.…”

Can conventional clinical chemistry tests help doctors in the monitoring of oncology patients?

“…multiple myeloma) may be accompanied by hyperphosphatemia [35]. An increase in serum phosphorus level can be observed as a result of tumour treatment [36][37][38]. A significant increase in serum phosphorus after tumour removal is a poor prognostic factor for patient survival [38].…”

“…An increase in serum phosphorus level can be observed as a result of tumour treatment [36][37][38]. A significant increase in serum phosphorus after tumour removal is a poor prognostic factor for patient survival [38]. Often, hyperphosphatemia is a typical sign of tumour lysis syndrome [39][40][41][42] and was proposed as one of the criteria of the laboratory tumour lysis syndrome diagnosis [43].…”

“…Moreover, the elevation of serum phosphate concentration higher than its upper normal limit (UNL) can transform an intermediate (1% to 5%) risk of tumour lysis syndrome development into a high (greater than 5%) risk in various lymphoproliferative disorders [41]. Hyperphosphatemia is a poor survival prognostic factor after surgical removal of colorectal tumours [38]. Detection of hyperphosphatemia is important for determining the cause of tumour-associated hypocalcaemia [27].…”