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The EPOS-CC Score: An Integration of Independent, Tumor- and Patient-Associated Risk Factors to Predict 5-years Overall Survival Following Colorectal Cancer Surgery

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Abstract

Background

Surgical audit is an essential task for the estimation of postoperative outcome and comparison of quality of care. Previous studies on surgical audits focused on short-term outcomes, such as postoperative mortality. We propose a surgical audit evaluating long-term outcome following colorectal cancer surgery. The predictive model for this audit is designated as ‘Estimation of Postoperative Overall Survival for Colorectal Cancer (EPOS-CC)’.

Methods

Thirty-one tumor-related and physiological variables were prospectively collected in 889 patients undergoing elective resection for colorectal cancer between April 2005 and April 2007 in 16 Japanese hospitals. Postoperative overall survival was assessed over a 5-years period. The EPOS-CC score was established by selecting significant variables in a uni- and multivariate analysis and allocating a risk-adjusted multiplication factor to each variable using Cox regression analysis. For validation, the EPOS-CC score was compared to the predictive power of UICC stage. Inter-hospital variability of the observed-to-estimated 5-years survival was assessed to estimate quality of care.

Results

Among the 889 patients, 804 (90 %) completed the 5-years follow-up. Univariate analysis displayed a significant correlation with 5-years survival for 14 physiological and nine tumor-related variables (p < 0.005). Highly significant p-values below 0.0001 were found for age, ASA score, severe pulmonary disease, respiratory history, performance status, hypoalbuminemia, alteration of hemoglobin, serum sodium level, and for all histological variables except tumor location. Age, TNM stage, lymphatic invasion, performance status, and serum sodium level were independent variables in the multivariate analysis and were entered the EPOS-CC model for the prediction of survival. Risk-adjusted multiplication factors between 1.5 (distant metastasis) and 0.16 (serum sodium level) were accorded to the different variables. The predictive power of EPOS-CC was superior to the one of UICC stage; area under the curve 0.87, 95 % CI 0.85–0.90 for EPOS-CC, and 0.80, 0.76–0.83 for UICC stage, p < 0.001. Quality of care did not differ between hospitals.

Conclusions

The EPOS-CC score including the independent variables age, performance status, serum sodium level, TNM stage, and lymphatic invasion is superior to the UICC stage in the prediction of 5-years overall survival. This higher accuracy might be explained by the inclusion of physiological factors, thus also taking non-tumor-associated deaths into account. Furthermore, EPOS-CC score may compare quality of care among different institutions. Future studies are necessary to further evaluate this score and help improving the prediction of long-term survival following colorectal cancer surgery.

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Acknowledgments

This work was supported by a grant of NHO Multi-Center Clinical Research for Evidence-Based Medicine. The authors wish to thank all of the institutional investigators listed below for their unstinting exertions in collecting data. H. Naito, M.D., NHO Hokkaido Cancer Center; M. Oohara, M.D., NHO Hokkaido Cardiovascular Center; A. Nagase, M.D., NHO Dohoku Hospital; H. Tsunoda, M.D., NHO Kofu National Hospital; K. Kondo, M.D., NHO Nagoya Medical Center; O. Kimura, M.D., NHO Yonago Medical Center; H. Takeuchi, M.D., NHO Iwakuni Clinical Center; T. Nakata, M.D., NHO Nagasaki Medical Center; H. Matsuzaki, M.D., NHO Kumamoto Medical Center; Y. Ogura, M.D., NHO Minami Kyushu National Hospital.

Conflict of interest

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Authors and Affiliations

  1. Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-Ku, Kumamoto, 8600008, Japan

    Yoshio Haga

  2. Department of International Medical Cooperation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 8608556, Japan

    Yoshio Haga

  3. Department of Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigohama, Chuo-Ku, Fukuoka, 8108563, Japan

    Koji Ikejiri

  4. Department of Surgery, National Hospital Organization Himeji Medical Center, 68 Honmachi, Himeji, 6708520, Japan

    Yasuo Wada

  5. Department of Surgery, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-Ku, Osaka, 5400006, Japan

    Masakazu Ikenaga

  6. Department of Surgery, National Hospital Organization Matsumoto Medical Center, 2-20-30 Muraimachiminami, Matsumoto, Nagano, 3998701, Japan

    Shoichiro Koike

  7. Department of Surgery, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, Gunma, 3700829, Japan

    Seiji Nakamura

  8. Department of Surgery, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima, 7370023, Japan

    Masato Koseki

Authors
  1. Yoshio Haga
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  2. Koji Ikejiri
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  3. Yasuo Wada
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  4. Masakazu Ikenaga
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  5. Shoichiro Koike
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  6. Seiji Nakamura
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  7. Masato Koseki
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Correspondence to Yoshio Haga.

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Haga, Y., Ikejiri, K., Wada, Y. et al. The EPOS-CC Score: An Integration of Independent, Tumor- and Patient-Associated Risk Factors to Predict 5-years Overall Survival Following Colorectal Cancer Surgery. World J Surg 39, 1567–1577 (2015). https://doi.org/10.1007/s00268-015-2962-3

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  • DOI: https://doi.org/10.1007/s00268-015-2962-3

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