Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1206
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
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.
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.
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.
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.
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%).
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.
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.