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Stage IV Colorectal Cancers: An Analysis of Factors Predicting Outcome and Survival in 728 cases

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Introduction

Stage IV colorectal cancer (CRC) is a heterogeneous disease with many treatment options. The optimum management algorithm is yet to be established. The aim of this study was to evaluate the prognostic factors of survival and to determine the operative benefit of resection of the primary tumour followed by chemotherapy.

Methods

Seven hundred twenty-eight consecutive patients who presented with stage IV CRC from 1999 to 2007 were identified. The demographics and clinicopathological characteristics of these patients were reviewed. Survival curves were constructed using the Kaplan–Meier method. Multivariate analysis assessed independent prognostic factors.

Results

In the surgical management of the primary, 79% (n = 572) were performed electively, 18% (n = 134) as an emergency procedure and 3% (n = 22) did not have any surgery. Twelve percent (n = 78) had a permanent stoma. Major morbidity was 4.3% (n = 31), and 30-day mortality was low at 6% (n = 46). Ten percent (n = 71) had a subsequent metasectomy. Patients who underwent curative resections tended to be female (p = 0.05), of a younger age group (age, ≤50; p = 0.005), as well as had better haemoglobin (p = 0.0001) and albumin levels (p = 0.0001). For the study cohort, the cancer-specific survival (CSS) at 1 year was 47.9% [95% confidence interval (CI), 44.2–51.6%], 3-year CSS was 10.8% (95% CI, 3.3–13.3%) and 5-year CSS was 7.0% (95% CI, 4.8–9.2%). CSS was significantly higher in patients that underwent colonic resection. In cases where resection of the primary was possible, multivariate analysis revealed that CEA value >40 ng/ml, low albumin levels ≤34 g/l, poorly differentiated tumours, advanced tumour stage (T3/T4), nodal disease (N1/N2) and presence of diffuse metastasis were all significant factors associated with poorer cancer-specific survival.

Conclusion

This study has shown a good survival benefit in stage IV CRC when an aggressive policy of primary resection is adopted. Resection of metastases with curative intent should be performed whenever possible.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Min-Hoe Chew, Jin-Yao Teo, Poh-Koon Koh, Kong-Weng Eu & Choong-Leong Tang

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Tousif Kabir

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  1. Min-Hoe Chew
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  2. Jin-Yao Teo
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  3. Tousif Kabir
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  4. Poh-Koon Koh
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  5. Kong-Weng Eu
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  6. Choong-Leong Tang
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Corresponding author

Correspondence to Choong-Leong Tang.

Additional information

The authors Dr. M.H. Chew, Dr. J.Y. Teo, T. Kabir, Dr. P.K. Koh, Prof. K.W. Eu and Prof. C.L. Tang were all involved in data acquisition, analysis and manuscript preparation as well as final approval.

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Chew, MH., Teo, JY., Kabir, T. et al. Stage IV Colorectal Cancers: An Analysis of Factors Predicting Outcome and Survival in 728 cases. J Gastrointest Surg 16, 603–612 (2012). https://doi.org/10.1007/s11605-011-1725-1

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  • DOI: https://doi.org/10.1007/s11605-011-1725-1

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