Brief Article
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World J Gastrointest Surg. Apr 27, 2013; 5(4): 104-109
Published online Apr 27, 2013. doi: 10.4240/wjgs.v5.i4.104
Clinical presentation predicts the outcome of patients with colon cancer
Offir Ben-Ishay, Zvi Peled, Amira Othman, Eran Brauner, Yoram Kluger
Offir Ben-Ishay, Zvi Peled, Amira Othman, Eran Brauner, Yoram Kluger, Department of General Surgery, Rambam Health Care Campus, Haifa 33271, Israel
Offir Ben-Ishay, Zvi Peled, Amira Othman, Eran Brauner, Yoram Kluger, the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 33271, Israel
Author contributions: Ben-Ishay O contributed to conception, design, acquisition, analysis, interpretation of data, and drafting of the manuscript; Peled Z and Othman A collected the data; Brauner E critically reviewed and analysised the data; Kluger Y contributed to conception, design, critical review and interpretation of the data, and final approval of the manuscript.
Correspondence to: Offir Ben-Ishay, MD, Department of General Surgery, Rambam Health Care Campus, Haifa 33271, Israel. o_ben-ishay@Rambam.health.gov.il
Telephone: +972-50-2063177 Fax: +972-4-8542871
Received: September 29, 2012
Revised: March 3, 2013
Accepted: March 8, 2013
Published online: April 27, 2013
Abstract

AIM: To elucidate the relationship between clinical presentation and outcome.

METHODS: A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality. An odds ratio based clinical score was created to evaluate the contribution of the quality of symptoms to outcome. Primary measure of outcome was survival.

RESULTS: During the study period, 236 patients met the inclusion criteria. Overall survival was 60.6%, mean follow-up 3.0 years. A bivariate analysis showed that increasing number of symptoms is not associated with mortality. However, a symptom-specific analysis performed using a logistic regression model controlling for age, stage and the duration of complaints revealed that the presence of melena was independently associated with mortality [P = 0.04, odds ratio (OR) 7.4], while rectal bleeding was associated with survival (P = 0.004, OR 3.9). Applying the proposed clinical score to an receiver operating characteristic curve showed that score > 1 had a strong association with mortality. The same logistic regression model was applied. The results showed that a score > 1 was an independent predictor of mortality (P < 0.001) and associated with node-positive disease (P = 0.008).

CONCLUSION: The quality of symptoms rather than quantity is correlated with outcome among patients with colon cancer. The proposed clinical scoring system may correctly predict the patient’s outcome.

Keywords: Colon cancer, Symptoms, Mortality

Core tip: Clinical presentation and its association with outcome among patients with colon cancer, although poorly studied in the past, may have an important role in predicting the outcomes among this important cohort of patients. Clinical scoring as proved in other areas in the past may have an important role in outcome prediction.