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
ARTICLE HIGHLIGHTS
Research background

The prognosis of colorectal cancer is poor. Surgery is the main treatment for patients with colorectal cancer. Accurate assessment of surgical prognosis has an important impact on the choice of treatments for patients. Currently, there are many methods to evaluate the prognosis after colorectal cancer surgery, including tumor-node-metastasis (TNM) stage, Glasgow prognostic score (GPS) score and so on. However, the systematic analysis about the factors affecting the prognosis of colorectal cancer is still limited.

Research motivation

Currently, the prognosis of colorectal cancer is mainly predicted by carcinoembryonic antigen (CEA) level, pathological classification, and TNM stage. However, the accuracy of prediction cannot be guaranteed due to the influence of individual and environmental factors. Besides, studies have revealed that some inflammatory indicators are also related to the prognosis of cancer.

Research objectives

In this study, we analyzed the influence of clinical data, serology, and histology on the prognosis of patients with colorectal cancer, and assessed the accuracy of the combination of all indicators for the prognosis evaluation. The purpose of this study was to provide a new method for predicting the prognosis of colorectal cancer in the early stage.

Research methods

A total of 374 patients were recruited, and the patients were divided into a good prognosis group and a poor prognosis group. Relevant clinical indicators were recorded. The differences in clinical data, serology, and histology between the two groups were analyzed. 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 test the accuracy of different indicators and their combination for the prognostic evaluation of colorectal cancer.

Research results

The TNM stage, proliferating cell nuclear antigen (PCNA), 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, D-dimer, and GPS had the highest predictive power for colorectal cancer prognosis. But their accuracies were significantly lower than that of the combination of all indicators (AUC = 0.973; sensitivity, 92.59%; specificity, 90.51%).

Research conclusions

TNM stage, PCNA, GPS, NLR, CAR, D-dimer, and CEA are the independent influencing factors for the prognosis of colorectal cancer. Combined evaluation of independent factors is the most accurate method to predict the prognosis of colorectal cancer.

Research perspectives

On the purpose of avoiding the interference caused by the differences of individual and environmental factors, multi-center studies would be considered to enlarge the size of simple to improve the reliability of the research results. Besides that, long-term research is also planned to make up the ignorance of the factors affecting long-term prognosis in this study.