Skip to main content
Log in

Prognostic predictors in colorectal cancer

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: Better prognostic predictors in colorectal cancer than the Dukes stage are necessary for individualized therapy and follow-up. METHODS: Survival among 212 patients operated on for colorectal cancer was examined regarding various clinical, histopathologic, cellular, and serologic tumor characteristics. RESULTS: Beside the Dukes stage, which was the most powerful variable, the erythrocyte sedimentation rate, leukocyte blood count, alkaline phosphatase, aspartate aminotransferase, six different serum tumor markers, number of small blood vessels, and age were found to be significantly associated with survival. The leukocyte blood count, alkaline phosphatase, and aspartate aminotransferase retained their significance in a multivariate model including tumor differentiation, local tumor stage, and age. Inclusion of tissue polypeptide antigen, the most powerful tumor marker in the multivariate model, showed that only the tumor stage, tissue polypeptide antigen, and age were statistically significantly correlated to survival. This was valid both for the group of patients considered as potentially curable and for those who potentially have been cured (Dukes Stages A-C). CONCLUSIONS: A great number of prognostic predictors failed to discard Dukes stage as the best one. One serum tumor marker, tissue polypeptide antigen, contains independent additional prognostic information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dukes CE, Bussey HJ. The spread of rectal cancer and its effect on prognosis. Br J Cancer 1958;12:309–20.

    Google Scholar 

  2. Chapuis PH, Dent OF, Fisher R,et al. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg 1985;72:698–702.

    Google Scholar 

  3. Wiggers T, Arends JW, Schutte B, Volovics L, Bosman FT. A multivariate analysis of pathologic prognostic indicators in large bowel cancer. Cancer 1988;61:386–95.

    Google Scholar 

  4. Ståhle E, Glimelius B, Bergström R, Påhlman L. Preoperative prediction of outcome in patients with rectal and rectosigmoid cancer. Cancer 1989;63:1831–7.

    Google Scholar 

  5. Nathanson SD, Schultz L, Tilley B, Kambouris A. Carcinomas of the colon and rectum: a comparison of staging classifications. Am Surg 1986;52:428–33.

    Google Scholar 

  6. Lindmark G, Glimelius B, Påhlman L, Enblad P. Heterogeneity in ploidy and S-phase fraction in colorectal adenocarcinomas. Int J Colorectal Dis 1991;6:115–20.

    Google Scholar 

  7. Lindmark G, Gerdin B, Påhlman L, Glimelius B, Gehlsen K, Rubin K. Interconnection of integrinsα 2 andα 3 and structure of the basal membrane: relation to survival. Eur J Surg Oncol 1993;19:50–60.

    Google Scholar 

  8. Lindmark G, Sundberg C, Glimelius B, Påhlman L, Rubin K, Gerdin B. Stromal expression of platelet-derived growth factor (PDGF)Β-receptor and PDGF B-chain in colorectal adenocarcinoma. Lab Invest 1993;69:682–89.

    Google Scholar 

  9. Halvorsen TB, Seim E. Degree of differentiation in colorectal adenocarcinomas: a multivariate analysis of the influence on survival. J Clin Pathol 1988;41:532–7.

    Google Scholar 

  10. Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med 1965;121:439–62.

    Google Scholar 

  11. Björklund B. On the nature and clinical use of tissue polypeptide antigen (TPA). Tumordiagnostik 1980;1:9–20.

    Google Scholar 

  12. Nilsson O, Johansson C, Glimelius B,et al. Sensitivity and specificity of CA 242 in gastrointestinal cancer: a comparison with CEA, CA 50 and CA 1∶9-9. Br J Cancer 1992;65:215–21.

    Google Scholar 

  13. Vindelöv LL, Christensen IJ, Nissen NI. A detergenttrypsin method for the preparation of nuclei for flow cytometric DNA analysis. Cytometry 1983;3:323–7.

    Google Scholar 

  14. Hiddemann W, Schumann J, Andreef M,et al. Convention of nomenclature for DNA cytometry. Cytometry 1984;5:445–6.

    Google Scholar 

  15. Wayner EA, Carter WG. Identification of multiple cell adhesion receptors for collagen and fibronectin in human fibrosarcoma cells possessing uniqueα and commonΒ subunits. J Cell Biol 1987;103:2457–65.

    Google Scholar 

  16. Rönnstrand L, Terracio L, Claesson-Welsh L, Heldin CH, Rubin K. Characterization of two monoclonal antibodies reactive with the external domain of the plateletderived growth factor receptor. J Biol Chem 1988;263:10429–35.

    Google Scholar 

  17. Lawless JF. Statistical models and methods for life-time data. New York: Wiley, 1982.

    Google Scholar 

  18. Hildebrandt U, Feifel G. Endorectal sonography. Surg Annu 1990;22:169–83.

    Google Scholar 

  19. Lindmark G, Elvin A, Påhlman L, Glimelius B. The value of endosonography in preoperative staging of rectal cancer. Int J Colorectal Dis 1992;7:162–6.

    Google Scholar 

  20. Lühtgens M, Schlegel G. Clinical use of the tumor marker system CEA-TPA. Leonberg: TumorDiagnostik Verlag, 1989.

    Google Scholar 

  21. Putzki H, Student A, Jablonski M, Heymann H. Comparison of the tumor markers CEA, TPA, and CA 19-9 in colorectal carcinoma. Cancer 1987;59:223–6.

    Google Scholar 

  22. Ståhle E, Glimelius B, Bergström R, Påhlman L. Preoperative serum markers in carcinoma of the rectum and rectosigmoid. II. Prediction of prognosis. Eur J Surg Oncol 1988;14:287–96.

    Google Scholar 

  23. Armitage NC, Ballantyne KC, Evans DF, Clarke P, Sheffield J, Hardcastle JD. The influence of tumour cell DNA content on survival in colorectal cancer: a detailed analysis. Br J Cancer 1990;62:852–6.

    Google Scholar 

  24. Bawani M, Tibrewala S, Copur S, Harris D, Gilman-Sachs A. DNA flow cytometry of colorectal carcinoma: correlation of DNA stemlines with other prognostic indices. Am J Gastroenterol 1991;86:191–5.

    Google Scholar 

  25. Wersto RP, Liblit RL, Deitch D, Koss LG. Variability in DNA measurements in multiple tumor samples of human colonic carcinoma. Cancer 1991;67:106–15.

    Google Scholar 

  26. Kuori M, Laasonen A, Mecklin JP, JÄrvinen H, Franssila K, Pyrhönen S. Diploid predominance in hereditary nonpolyposis colorectal carcinoma evaluated by flow cytometry. Cancer 1990;65:1825–9.

    Google Scholar 

  27. Enblad P, Glimelius B, Bengtsson A, Pontén J, Påhlman L. DNA content in carcinoma of the rectum and rectosigmoid. Acta Pathol Microbiol Immunol Scand: A 1985;93:277–84.

    Google Scholar 

  28. Ruoslahti E. Integrins. J Clin Invest 1991;87:1–5.

    Google Scholar 

  29. Dedhar S. Integrins and tumor invasion. Bioessays 1990;12:583–90.

    Google Scholar 

  30. Hewitt RE, Powe DG, Griffin NR, Turner DR. Relationships between epithelial basement membrane staining patterns in primary colorectal carcinomas and the extent of tumor spread. Int J Cancer 1991;48:855–60.

    Google Scholar 

  31. Heldin CH, Westermark B. Platelet-derived growth factor: mechanism of action and possiblein vivo function. Cell Regul 1990;1:555–66.

    Google Scholar 

  32. Ito M, Yoshida K, Kyo E,et al. Expression of several growth factors and their receptor genes in human colon carcinomas. Virchows Arch B Cell Pathol 1990;59:173–8.

    Google Scholar 

  33. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis-correlation in invasive breast carcinoma. N Engl J Med 1991;324:1–8.

    Google Scholar 

  34. Påhlman L, Glimelius B. Preoperative and postoperative radiotherapy and rectal cancer. World J Surg 1992;16:858–65.

    Google Scholar 

  35. Metzger UF, Ghosh BC, Kisner DL. Adjuvant treatment of colorectal cancer. Cancer Chemother Pharmacol 1985;14:1–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Supported by grants from the Swedish Cancer Society (Project No. 1921-B92-10XAC), the Swedish Medical Society, and the University Hospital Cancer Foundation.

About this article

Cite this article

Lindmark, G., Gerdin, B., Påhlman, L. et al. Prognostic predictors in colorectal cancer. Dis Colon Rectum 37, 1219–1227 (1994). https://doi.org/10.1007/BF02257785

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02257785

Key words

Navigation