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Prognostic Factors Assessed for 15,096 Patients with Colon Cancer in Stages I and II

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Abstract

Background

We focused on the risk factors for poor outcome after curative resection of a colon cancer in UICC stages I and II based on the data of the Germany-wide quality assurance study “colon/rectum cancer (primary tumor).” In some countries, all stage II colon cancer patients are encouraged to participate in a clinical trial. We feel that this approach is too broad.

Methods

Using the data of 15,096 patients operated on from January 1, 2000 to December 31, 2004, the following factors were analyzed with the Cox regression model: age, comorbidities, ASA score, gender, localization of the tumor (left colon vs. right colon), perioperative complications (yes/no), pT stage, grading (G1/G2 vs. G3/G4), L-status (lymph vessels invasion yes/no), and V-status (venous invasion yes/no).

Results

The probability of a local relapse in stages I and II was 1.5 and 4.6%, respectively, or distant metastases 4.7 and 10.2%, respectively. Only pT stage [hazard ratio (HR) for pT1 = 1, pT2 = 1.821, pT3 = 2.735, and pT4 = 5.881], L-status (HR for L1 = 1.393), age (HR per year = 1.021), as well as ASA score IV (HR = 4.536) had significant influence on tumor-free survival.

Conclusions

Despite favorable prognosis and R0 resection, a small percentage of patients will still relapse. The most important risk factor comprising the tumor-free survival is the pT stage followed by L-status and age. These results should be taken into consideration when determining the course for adjuvant chemotherapy, especially if the course includes the recommendation of clinical trial participation for stage II colon cancer patients after an R0 resection.

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Conflicts of interest

The authors declare that no real or potential conflicts of interest exist.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Pawel Mroczkowski & Hans Lippert

  2. Institute of Quality Assurance in Operative Medicine Ltd, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Pawel Mroczkowski, Ingo Gastinger, Hans Lippert & Rainer Kube

  3. StatConsult, Halberstädter Str. 40a, 39112, Magdeburg, Germany

    Uwe Schmidt

  4. Department of Surgery, Red Cross Clinic, Berlin/Koepenick Salvador-Allende-Straße 2–8, 12559, Berlin, Germany

    Maik Sahm

  5. Department of Surgery, Carl-Thiem-Klinikum Cottbus, Thiemstraße 111, 03048, Cottbus, Germany

    Rainer Kube

Authors
  1. Pawel Mroczkowski
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  2. Uwe Schmidt
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  3. Maik Sahm
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  4. Ingo Gastinger
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  5. Hans Lippert
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  6. Rainer Kube
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Corresponding author

Correspondence to Pawel Mroczkowski.

Additional information

This study was conducted for the study group “Quality Assurance Colon/Rectum Cancer (Primary Tumor)”.

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Mroczkowski, P., Schmidt, U., Sahm, M. et al. Prognostic Factors Assessed for 15,096 Patients with Colon Cancer in Stages I and II. World J Surg 36, 1693–1698 (2012). https://doi.org/10.1007/s00268-012-1531-2

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