Abstract
Background
Stage IV colorectal cancer encompasses various clinical conditions. The aim of this study was to validate the utility of the recent AJCC stage IV colorectal cancer sub-classification, and to establish a prognostic scoring system using independent factors.
Methods
We conducted a retrospective analysis using data from the multicenter registry. Factors affecting the curative resection and prognosis were analyzed in patients with stage IV colorectal cancer.
Results
Of the 60,176 patients who received surgery for colorectal cancer, 9,624 (16.0 %) were classified as stage IV. The prognoses of patients with peritoneum-only metastasis were superior to those of patients with a stage IVB (P < 0.0001). Of the 11 independent prognostic factors identified, eight with a hazard ratio greater than 1.3 (depth of tumor invasion, regional lymph node metastasis, histologic grade, liver metastasis, lung metastasis, distant lymph node metastasis, peritoneal metastasis, and curative resection) were used in the prognostic scoring system. The scoring system gave one or two points for the presence of each prognosis risk factor, resulting in a total score ranging from 0 to 9. The 5-year overall survival rates of patients with a total score of 0–2, 3, 4, 5, and 6–9 were 50.4, 30.4, 17.7, 7.7, and 4.0 %, respectively (P < 0.0001).
Conclusion
Although the AJCC staging for patients with stage IV colorectal cancer reflected the prognosis, patients with peritoneum-only metastases should be classified as stage IVA. The prognostic scoring system using eight independent factors is useful in predicting the survival of patients with stage IV colorectal cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jemal A, Siegel R, Xu J et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300
Kotake K, Honjo S, Sugihara K et al (2003) Changes in colorectal cancer during a 20-year period: an extended report from the multi-institutional registry of large bowel cancer, Japan. Dis Colon Rectum 46:S32–S43
Muto T, Kotake K, Koyama Y (2001) Colorectal cancer statistics in Japan: data from JSCCR registration, 1974–1993. Int J Clin Oncol 6:171–176
American Joint Committee on Cancer (2010) AJCC Cancer staging manual 7th edition. Springer, New York
Bokemeyer C, Bondarenko I, Makhson A et al (2009) Fluorouracil, leucovorin, and oxaliplatin with and without cetuximab in the first-line treatment of metastatic colorectal cancer. J Clin Oncol 27:663–671
de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947
Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342
Saltz LB, Cox JV, Blanke C et al (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914
Tournigand C, Andre T, Achille E et al (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22:229–237 (Epub 2003 Dec 2002)
Van Cutsem E, Kohne CH, Hitre E et al (2009) Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. New Engl J Med 360:1408–1417
Adam R, Avisar E, Ariche A et al (2001) Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol 8:347–353
Bismuth H, Adam R, Levi F et al (1996) Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg 224:509–520 (discussion 520–502)
Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classification of colorectal carcinoma. Kanehara & Co., Ltd., Tokyo
Platell C, Ng S, O’Bichere A et al (2011) Changing management and survival in patients with stage IV colorectal cancer. Dis Colon Rectum 54:214–219
Kobayashi H, Enomoto M, Higuchi T et al (2010) Validation and clinical use of the Japanese classification of colorectal carcinomatosis: benefit of surgical cytoreduction even without hyperthermic intraperitoneal chemotherapy. Dig Surg 27:473–480
Kobayashi H, Mochizuki H, Sugihara K et al (2007) Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 141:67–75
Adam R, Delvart V, Pascal G, et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657 (Discussion 657–648)
Conflict of interest
All authors declare that they have no conflict of interest in this manuscript.
Author information
Authors and Affiliations
Corresponding author
Additional information
On behalf of the Japanese Society for Cancer of the Colon and Rectum.
About this article
Cite this article
Kobayashi, H., Kotake, K. & Sugihara, K. Prognostic scoring system for stage IV colorectal cancer: is the AJCC sub-classification of stage IV colorectal cancer appropriate?. Int J Clin Oncol 18, 696–703 (2013). https://doi.org/10.1007/s10147-012-0433-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10147-012-0433-5