Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1206-1217
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1206
Analysis of factors potentially predicting prognosis of colorectal cancer
Li-Jun Jin, Wei-Bin Chen, Xiao-Yu Zhang, Jie Bai, Hao-Chen Zhao, Zun-Yi Wang
Li-Jun Jin, Xiao-Yu Zhang, Jie Bai, Zun-Yi Wang, Department of Surgical Oncology (Division III), Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Wei-Bin Chen, Department of Radiology, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei Province, China
Hao-Chen Zhao, Department of Anesthesiology (Division II), Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Author contributions: Jin LJ, Chen WB, Zhang XY, Bai J, Bai J, and Wang ZY designed the research; Jin LJ, Zhang XY, Bai J, and Wang ZY performed the research; Chen WB and Zhao HC contributed new analytic tools; Jin LJ, Zhao HC, and Wang ZY analyzed the data; and Jin LJ, Chen WB, Zhao HC, and Wang ZY wrote the paper.
Institutional review board statement: The study was approved by the Ethics Committee of Cangzhou Central Hospital.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zun-Yi Wang, MD, Doctor, Department of Surgical Oncology (Division III), Cangzhou Central Hospital, No. 16, Xinhua Road West, Cangzhou 061001, Hebei Province, China. czwzy99@163.com
Telephone: +86-317-2075979
Received: June 12, 2019
Peer-review started: June 18, 2019
First decision: July 31, 2019
Revised: August 5, 2019
Accepted: August 26, 2019
Article in press: August 26, 2019
Published online: December 15, 2019
Processing time: 181 Days and 18.7 Hours
Abstract
BACKGROUND

Accurate assessment of the prognosis after colorectal cancer surgery is of great significance in patients with colorectal cancer. However, there is no systematic analysis of factors affecting the prognosis of colorectal cancer currently.

AIM

To systematically analyze the influence of clinical data and serological and histological indicators on the prognosis of patients with colorectal cancer, and to explore the indicators that can accurately assess the prognosis of patients with colorectal cancer.

METHODS

A total of 374 patients with colorectal cancer were enrolled. The clinical data, tumor-node-metastasis (TNM) stage, and Dukes stage were recorded. All patients received examinations including carcinoembryonic antigen (CEA), carbohydrate antigen 199, C-reactive protein, albumin, D-dimer, and fibrinogen as well as routine blood tests one week before surgery. The tumor location, size, depth of invasion, lymph node metastasis, and distant metastasis were recorded during surgery. The pathological tissue typing and expression of proliferating cell nuclear antigen (PCNA) and p53 were observed. All patients were followed for 3 years, and patients with endpoint events were defined as a poor prognosis group, and the remaining patients were defined as a good prognosis group. The differences in clinical data, serology, and histology were analyzed between the two groups. Multivariate COX regression was used to analyze the independent influencing factors for the prognosis of colorectal cancer. The receiver operating characteristic curve was used to evaluate the predictive value of each of the independent influencing factors and their combination for the prognosis of colorectal cancer.

RESULTS

The follow-up outcomes showed that 81 patients were in the good prognosis group and 274 patients in the poor prognosis group. The TNM stage, PCNA, Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), D-dimer, and CEA were independent influencing factors for the prognosis of colorectal cancer (P = 0.000). NLR had the highest predictive power for colorectal cancer prognosis [area under the receiver operating characteristic curve (AUC) = 0.925], followed by D-dimer (AUC = 0.879) and GPS (AUC = 0.872). The accuracy of the combination of all indicators in predicting the prognosis of colorectal cancer was the highest (AUC = 0.973), which was significantly higher than that of any of the indicators alone (P < 0.05). The sensitivity and specificity of the combination were 92.59% and 90.51%, respectively.

CONCLUSION

The independent influence factors for the prognosis of colorectal cancer include TNM stage, PCNA, GPS, NLR, CAR, D-dimer, and CEA. The combined assessment of the independent factors is the most accurate predictor of the prognosis after colorectal cancer surgery.

Keywords: Colorectal cancer; Prognosis; Influencing factors; Combination assessment

Core tip: Accurate assessment of the prognosis after colorectal cancer surgery is of great importance in patients with colorectal cancer. This study systematically analyzed the influence of clinical data and serological and histological indicators on the prognosis of patients with colorectal cancer and the results revealed that the independent influence factors for the prognosis of colorectal cancer include tumor-node-metastasis stage, proliferating cell nuclear antigen, Glasgow prognostic score, neutrophil-lymphocyte ratio, C-reactive protein/albumin ratio, D-dimer, and carcinoembryonic antigen. The combined assessment of the independent factors is the most accurate predictor of the prognosis after colorectal cancer surgery.