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POSSUM Predicts Decreased Overall Survival in Curative Resection for Colorectal Cancer

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Diseases of the Colon & Rectum

Purpose

Poor condition at operation determined by the physiologic POSSUM score is related to postoperative mortality and morbidity of colorectal cancer surgery. This study was designed to analyze the relationship between condition of patients with colorectal cancer at operation and long-term overall survival.

Methods

A total of 542 patients survived a radical resection for Stages I, II, or III colorectal cancer. Physiologic POSSUM score at surgery, exclusive of age, was calculated for all patients. Mean physiologic POSSUM score was used as cutoff point to determine low-risk and high-risk group patients. A Cox proportional hazard analysis was performed to study the effect of low-risk and high-risk group on overall survival and to identify independent risk factors.

Results

Five-year overall survival was significantly higher in low-risk group patients than in high-risk group patients (low-risk group 66.6 percent vs. high-risk group 48.5 percent; P < 0.001). Differences in overall survival also were found when patients in Stages I, II, and III were analyzed separately. Risk factors for overall survival were advanced stage of disease, poor tumor differentiation, mucinous adenocarcinoma, older than age 70 years, and poor condition of the patient at time of operation.

Conclusions

Poor condition at operation, as determined by physiologic POSSUM score, is a risk indicator for long-term overall survival in colorectal cancer patients.

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References

  1. O Visser S Siesling JA Dijck Particlevan (2003) Incidence of cancer in the Netherlands 1999/2000. Eleventh report of the Netherlands Cancer Registry Association of Comprehensive Cancer Centres Utrecht

    Google Scholar 

  2. R Yanick M Wesley L Ries et al. (1998) ArticleTitleComorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients Cancer 82 2123–2134 Occurrence Handle10.1002/(SICI)1097-0142(19980601)82:11<2123::AID-CNCR6>3.0.CO;2-W

    Article  Google Scholar 

  3. L Repetto A Venturino M Vercelli et al. (1998) ArticleTitlePerformance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions Cancer 82 760–765 Occurrence Handle9477110 Occurrence Handle1:STN:280:DyaK1c7jsF2ktQ%3D%3D Occurrence Handle10.1002/(SICI)1097-0142(19980215)82:4<760::AID-CNCR20>3.0.CO;2-V

    Article  PubMed  CAS  Google Scholar 

  4. JF Piccirillo RM Tierney I Costas L Grove EL Spitznagel (2004) ArticleTitlePrognostic importance of comorbidity in a hospital-based cancer registry JAMA 291 2441–2447 Occurrence Handle15161894 Occurrence Handle1:CAS:528:DC%2BD2cXksVegsr8%3D Occurrence Handle10.1001/jama.291.20.2441

    Article  PubMed  CAS  Google Scholar 

  5. WL Read RM Tierney NC Page et al. (2004) ArticleTitleDifferential prognostic impact of comorbidity J Clin Oncol 22 3099–3103 Occurrence Handle15284260 Occurrence Handle10.1200/JCO.2004.08.040

    Article  PubMed  Google Scholar 

  6. JF Piccirillo AR Feinstein (1996) ArticleTitleClinical symptoms and comorbidity: significance for the prognostic classification of cancer Cancer 77 834–842 Occurrence Handle8608472 Occurrence Handle1:STN:280:BymC1crjsF0%3D Occurrence Handle10.1002/(SICI)1097-0142(19960301)77:5<834::AID-CNCR5>3.0.CO;2-E

    Article  PubMed  CAS  Google Scholar 

  7. JF Piccirillo (1995) ArticleTitleInclusion of comorbidity in a staging system for head and neck cancer Oncology 9 831–836 Occurrence Handle8562325 Occurrence Handle1:STN:280:BymD1Mfms1M%3D

    PubMed  CAS  Google Scholar 

  8. KC Ribeiro LP Kowalski MR Latorre (2000) ArticleTitleImpact of comorbidity, symptoms, and patients' characteristics on the prognosis of oral carcinomas Arch Otolaryngol Head Neck Surg 126 1079–1085 Occurrence Handle10979120 Occurrence Handle1:STN:280:DC%2BD3cvmvFSqtg%3D%3D

    PubMed  CAS  Google Scholar 

  9. KC Ribeiro LP Kowalski M Latorre (2003) ArticleTitlePerioperative complications, comorbidities and survival in oral or oropharyngeal cancer Arch Otolaryngol Head Neck Surg 129 219–228

    Google Scholar 

  10. M Diculescu R Iacob S Iacob A Croitoru G Becheanu V Popeneciu (2002) ArticleTitleThe importance of histopathological and clinical variables in predicting the evolution of colon cancer Rom J Gastroenterol 11 183–189 Occurrence Handle12368937 Occurrence Handle10.1159/000065816

    Article  PubMed  Google Scholar 

  11. RJ Rieker E Hammer R Eisele E Schmid J Hogel (2002) ArticleTitleThe impact of comorbidity on the overall survival and the cause of death in patients after colorectal cancer resection Langenbeck's Arch Surg 387 72–76 Occurrence Handle10.1007/s00423-002-0291-0

    Article  Google Scholar 

  12. GP Copeland D Jones M Walters (1991) ArticleTitlePOSSUM: a scoringssystem for surgical audit Br J Surg 78 356–360

    Google Scholar 

  13. LH Sobin Wittekind (2002) TNM classificaton of malignant tumours. Union International Contre le Cancer EditionNumber6th ed. Wiley-Liss New York 72–76

    Google Scholar 

  14. SR Hamilton LA Aaltonen (2000) Pathology and genetics of tumours of the digestive system. World Health Organization Classification of Tumours IARC Press Lyon 104–119

    Google Scholar 

  15. T Anthony C Simmang N Hyman et al. (2004) ArticleTitlePractice parameters for the surveillance and follow-up of patients with colon and rectal cancer Dis Colon Rectum 47 807–817 Occurrence Handle15108028 Occurrence Handle10.1007/s10350-004-0519-x

    Article  PubMed  Google Scholar 

  16. GP Copeland (2002) ArticleTitleThe POSSUM system of surgical audit Arch Surg 137 15–20 Occurrence Handle11772209 Occurrence Handle10.1001/archsurg.137.1.15

    Article  PubMed  Google Scholar 

  17. WD Neary BP Heather JJ Earnshaw (2003) ArticleTitleThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) Br J Surg 90 157–165 Occurrence Handle12555290 Occurrence Handle10.1002/bjs.4041

    Article  PubMed  Google Scholar 

  18. WA Satarino DR Ragland (1994) ArticleTitleThe effect of comorbidity on 3-year survival of women with primary breast cancer Ann Intern Med 120 104–110

    Google Scholar 

  19. C Ko S Chaudhry (2002) ArticleTitleThe need for a multidisciplinary approach to cancer care J Surg Res 105 53–57 Occurrence Handle12069502 Occurrence Handle10.1006/jsre.2002.6449

    Article  PubMed  Google Scholar 

  20. P Simmonds L Best S George InstitutionalAuthorNameColorectal Cancer Collaborative Group et al. (2000) ArticleTitleSurgery for colorectal cancer in elderly patients: a systematic review Lancet 356 968–974 Occurrence Handle10.1016/S0140-6736(00)02713-6

    Article  Google Scholar 

  21. R Yanick PA Ganz CG Varricchio B Conely (2001) ArticleTitlePerspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base J Clin Oncol 19 1147–1151

    Google Scholar 

  22. ER Greimel GV Padilla MM Grant (1997) ArticleTitlePhysical and psychosocial outcomes in cancer patients: a comparison of different age groups Br J Cancer 76 251–255 Occurrence Handle9231927 Occurrence Handle1:STN:280:ByiA2srmtFQ%3D

    PubMed  CAS  Google Scholar 

  23. TH Walsh (1996) ArticleTitleAudit of outcome of major surgery in the elderly Br J Surg 83 92–97 Occurrence Handle8653377 Occurrence Handle1:STN:280:BymB28vgsF0%3D Occurrence Handle10.1046/j.1365-2168.1996.02043.x

    Article  PubMed  CAS  Google Scholar 

  24. DJ Sargent RM Goldberg S Jacobson et al. (2001) ArticleTitleA pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients N Engl J Med 345 1091–1097 Occurrence Handle11596588 Occurrence Handle1:STN:280:DC%2BD3MrkvFKhtg%3D%3D Occurrence Handle10.1056/NEJMoa010957

    Article  PubMed  CAS  Google Scholar 

  25. N Vey D Coso VJ Bardou et al. (2004) ArticleTitleThe benefit of induction chemotherapy in patients age > or = 75 years Cancer 101 325–331 Occurrence Handle15241830 Occurrence Handle1:CAS:528:DC%2BD2cXmsVKlsLk%3D Occurrence Handle10.1002/cncr.20353

    Article  PubMed  CAS  Google Scholar 

  26. TJ Iwashyna EB Lamont (2002) ArticleTitleEffectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer J Clin Oncol 20 3992–3998 Occurrence Handle12351596 Occurrence Handle1:CAS:528:DC%2BD38XntF2jsLk%3D Occurrence Handle10.1200/JCO.2002.03.083

    Article  PubMed  CAS  Google Scholar 

  27. H Chen A Cantor J Meyer et al. (2003) ArticleTitleCan older cancer patients tolerate chemotherapy? A prospective pilot study Cancer 97 1107–1114 Occurrence Handle12569613 Occurrence Handle10.1002/cncr.11110

    Article  PubMed  Google Scholar 

  28. EL Trimble CL Carter D Cain B Friedlin RS Ungerleider MA Friedman (1994) ArticleTitleRepresentation of older patients in cancer treatment trials Cancer 74 2208–2214 Occurrence Handle8087794 Occurrence Handle1:STN:280:ByuA2szns1Q%3D

    PubMed  CAS  Google Scholar 

  29. LF Hutchins JM Unger JJ Crowley CA Colyman KS Albain (1999) ArticleTitleUnderrepresentation of patients 65 years of age or older in cancer-treatment trials N Engl J Med 341 2061–2067 Occurrence Handle10615079 Occurrence Handle1:STN:280:DC%2BD3c%2Fmt1Sjsg%3D%3D Occurrence Handle10.1056/NEJM199912303412706

    Article  PubMed  CAS  Google Scholar 

  30. VH Murthy HM Krumholz CP Gross (2004) ArticleTitleParticipation in cancer clinical trials: race-, sex-, and age-based disparities JAMA 291 2720–2726 Occurrence Handle15187053 Occurrence Handle1:CAS:528:DC%2BD2cXkvVeqsL4%3D Occurrence Handle10.1001/jama.291.22.2720

    Article  PubMed  CAS  Google Scholar 

  31. HJ Jones L Cossart Particlede (1999) ArticleTitleRisk scoring in surgical patients Br J Surg 86 149–157 Occurrence Handle10100780 Occurrence Handle1:STN:280:DyaK1M7pvVykuw%3D%3D Occurrence Handle10.1046/j.1365-2168.1999.01006.x

    Article  PubMed  CAS  Google Scholar 

  32. DR Jones GP Copeland L Cossart Particlede (1992) ArticleTitleComparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit Br J Surg 79 1293–1296 Occurrence Handle1486421 Occurrence Handle1:STN:280:ByyC3snptlI%3D

    PubMed  CAS  Google Scholar 

  33. WD Neary P Crow C Foy D Prytherch BP Heather JJ Earnshaw (2003) ArticleTitleComparison of POSSUM scoring and the Hardman Index in selection patients for repair of ruptured abdominal aortic aneurysm Br J Surg 90 421–425 Occurrence Handle12673742 Occurrence Handle1:STN:280:DC%2BD3s7ls1yitg%3D%3D Occurrence Handle10.1002/bjs.4061

    Article  PubMed  CAS  Google Scholar 

  34. KC Ribeiro LP Kowalski (2003) ArticleTitleAPACHE II, POSSUM and ASA scores and the risk of perioperative complications in patients with oral or oropharyngeal cancer Arch Otolaryngol Head Neck Surg 129 739–745 Occurrence Handle10.1001/archotol.129.7.739

    Article  Google Scholar 

  35. AJ Senagore AJ Warmuth CP Delaney PP Tekkis VW Fazio (2004) ArticleTitlePOSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection Dis Colon Rectum 47 1435–1441 Occurrence Handle15486738 Occurrence Handle10.1007/s10350-004-0694-9

    Article  PubMed  Google Scholar 

  36. PM Sagar MN Hartley B Mancey-Jones PC Sedman J May J MacFie (1994) ArticleTitleComparative audit of colorectal resection with the POSSUM scoring system Br J Surg 81 1492–1494 Occurrence Handle7820482 Occurrence Handle1:STN:280:ByqC38%2FjvFM%3D

    PubMed  CAS  Google Scholar 

  37. PM Sagar MN Hartley J MacFie BA Taylor GP Copeland (1996) ArticleTitleComparison of individual surgeon's performance. Risk adjusted analysis with POSSUM scorings system Dis Colon Rectum 39 654–658 Occurrence Handle8646952 Occurrence Handle1:STN:280:BymB2cbgslw%3D Occurrence Handle10.1007/BF02056945

    Article  PubMed  CAS  Google Scholar 

  38. PP Tekkis HM Kocher AJ Bentley et al. (2000) ArticleTitleOperative mortality rates among surgeons: comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery Dis Colon Rectum 43 1528–1532 Occurrence Handle11089587 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt1Gjuw%3D%3D Occurrence Handle10.1007/BF02236732

    Article  PubMed  CAS  Google Scholar 

  39. PP Tekkis N Kessaris HM Kocher JD Poloniecki J Lyttle AC Windsor (2003) ArticleTitleEvaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery Br J Surg 90 340–345 Occurrence Handle12594670 Occurrence Handle1:STN:280:DC%2BD3s%2Fot1Oitw%3D%3D Occurrence Handle10.1002/bjs.4037

    Article  PubMed  CAS  Google Scholar 

  40. KV Menon R Farouk (2002) ArticleTitleAn analysis of the accuracy of P-POSSUM scoring for mortality risk assessment after surgery for colorectal cancer Colorectal Dis 4 197–200 Occurrence Handle12780616 Occurrence Handle10.1046/j.1463-1318.2002.00334.x

    Article  PubMed  Google Scholar 

  41. PP Tekkis DR Prytherch HM Kocher et al. (2004) ArticleTitleDevelopment of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM) Br J Surg 91 1174–1182 Occurrence Handle15449270 Occurrence Handle1:STN:280:DC%2BD2cvnvFSltQ%3D%3D Occurrence Handle10.1002/bjs.4430

    Article  PubMed  CAS  Google Scholar 

  42. I Todd (1989) Guidelines to clinical audit in surgical practice. Advice document Royal College of Surgeons of England London

    Google Scholar 

  43. A Brunelli A Fianchini R Gesuita F Carle (1999) ArticleTitlePOSSUM scoring system as an instrument of audit in lung surgery. Physiological and operative severity score for enumeration of mortality and morbidity Ann Thorac Surg 67 329–331 Occurrence Handle10197649 Occurrence Handle1:STN:280:DyaK1M3htFGjtA%3D%3D Occurrence Handle10.1016/S0003-4975(98)00822-4

    Article  PubMed  CAS  Google Scholar 

  44. S Al-Homoud S Purkayastha O Aziz et al. (2004) ArticleTitleEvaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models Surg Oncol 13 83–92 Occurrence Handle15572090 Occurrence Handle10.1016/j.suronc.2004.08.006

    Article  PubMed  Google Scholar 

  45. DR Prytherch BM Ridler JD Beard JJ Earnshaw (2001) ArticleTitleAudit and research committee, The Vascular Surgical Society of Great Britain and Ireland. A model for national outcome audit in vascular surgery Eur J Endovasc Surg 21 477–483 Occurrence Handle1:STN:280:DC%2BD3MzivFOrsw%3D%3D Occurrence Handle10.1053/ejvs.2001.1369

    Article  CAS  Google Scholar 

  46. F Sommer A Ehsan T Klotz G Haupt HP Caspers U Engelman (2001) ArticleTitleComparison of individual urologists' performance Eur Urol 39 369–374 Occurrence Handle11306873 Occurrence Handle1:STN:280:DC%2BD3Mrjslakuw%3D%3D Occurrence Handle10.1159/000052472

    Article  PubMed  CAS  Google Scholar 

  47. RS Mohil D Bhatnagar L Bahadur Rajneesh DK Dev M Magan (2004) ArticleTitlePOSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy Br J Surg 91 500–503 Occurrence Handle15048756 Occurrence Handle1:STN:280:DC%2BD2c7lsVWntA%3D%3D Occurrence Handle10.1002/bjs.4465

    Article  PubMed  CAS  Google Scholar 

  48. E Bennett-Guerrero JA Hyam S Shaefi et al. (2003) ArticleTitleComparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK Br J Surg 90 1593–1598 Occurrence Handle14648741 Occurrence Handle1:STN:280:DC%2BD3srmsFOqsQ%3D%3D Occurrence Handle10.1002/bjs.4347

    Article  PubMed  CAS  Google Scholar 

  49. VE Lemmens ML Janssen-Heijnen CD Verheij S Houterman OJ Repelaer van Driel JW Coebergh (2005) ArticleTitleCo-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer Br J Surg 92 615–623 Occurrence Handle15779071 Occurrence Handle1:STN:280:DC%2BD2M3islyitQ%3D%3D Occurrence Handle10.1002/bjs.4913

    Article  PubMed  CAS  Google Scholar 

  50. RR Kelz PA Gimotty D Polsky S Norman D Fraker A DeMichele (2004) ArticleTitleMorbidity and mortality of colorectal carcinoma surgery differs by insurance status Cancer 101 2187–2194 Occurrence Handle15382089 Occurrence Handle10.1002/cncr.20624

    Article  PubMed  Google Scholar 

  51. A Alves Y Panis P Mathieu F Kwiatkowski K Slim G Mantion (2005) ArticleTitlePostoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a multicenter study Arch Surg 140 278–284 Occurrence Handle15781793 Occurrence Handle10.1001/archsurg.140.3.278

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Zaans Medical Centre, Zaandam, The Netherlands

    Rebecca P. Brosens M.D., Joannes L. Oomen M.D., Afina S. Glas Ph.D. & Alexander F. Engel Ph.D.

  2. Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands

    Afina S. Glas Ph.D.

  3. Department of Medical Oncology, Zaans Medical Centre, Zaandam, The Netherlands

    Aart van Bochove Ph.D.

  4. Department of Surgery, VU Medical Centre, Amsterdam, The Netherlands

    Miguel A. Cuesta Ph.D.

  5. Department of Surgery, Zaans Medical Centre, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands

    Rebecca P. Brosens M.D.

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  1. Rebecca P. Brosens M.D.
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  2. Joannes L. Oomen M.D.
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  3. Afina S. Glas Ph.D.
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  6. Alexander F. Engel Ph.D.
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Correspondence to Rebecca P. Brosens M.D..

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Brosens, R.P., Oomen, J.L., Glas, A.S. et al. POSSUM Predicts Decreased Overall Survival in Curative Resection for Colorectal Cancer. Dis Colon Rectum 49, 825–832 (2006). https://doi.org/10.1007/s10350-005-0284-5

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