Preoperative serum carcinoembryonic antigen, albumin and age are supplementary to UICC staging systems in predicting survival for colorectal cancer patients undergoing surgical treatment.
BACKGROUND
The aim of this study was to determine influence of prognostic factors in addition to UICC staging systems, on cancer-specific and overall survival rates for patients with colorectal cancer (CRC) undergoing surgical treatment.


METHODS
Between January 1996 and December 2006, a total of 1367 CRC patients who underwent surgical treatment in Kaohsiung Medical University Hospital were analyzed. We retrospectively investigated clinicopathologic features of these patients. All patients were followed up intensively, and their outcomes were investigated completely.


RESULTS
Of 1367 CRC patients, there were seven hundred and fifty-seven males (55.4%) and 610 (44.6%) females. The median follow-up period was 60 months (range, 3-132 months). A multivariate analysis identified that low serum albumin level (P = 0.011), advanced UICC stage (P < 0.001), and high carcinoembryonic antigen (CEA) level (P < 0.001) were independent prognostic factors of cancer-specific survival. Meanwhile, a multivariate analysis showed age over 65 years (P < 0.001), advanced UICC stage (P < 0.001), and high CEA level (P < 0.001) were independent prognostic factors of overall survival. Furthermore, combination of UICC stage, serum CEA and albumin levels as predictors of cancer-specific survival showed that the poorer the prognostic factors involved, the poorer the cancer-specific survival rate. Likewise, combination of UICC stage, age and serum CEA level as predictors of overall survival showed that the poorer the prognostic factors involved, the poorer the overall survival rate. Of these prognostic factors, preoperative serum CEA level was the only significant prognostic factor for patients with stage II and III CRCs in both cancer-specific and overall survival categories.


CONCLUSIONS
Preoperative serum albumin level, CEA level and age could prominently affect postoperative outcome of CRC patients undergoing surgical treatment. In addition to conventional UICC staging system, it might be imperative to take these additional characteristics of factors into account in CRC patients prior to surgical treatment.
Sun
Li-Chu
LC
Nutrition Service Team, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC. lichsu@cc.kmu.edu.tw
Chu
Koung-Shing
KS
Cheng
Su-Chen
SC
Lu
Chien-Yu
CY
Kuo
Chao-Hung
CH
Hsieh
Jan-Sing
JS
Shih
Ying-Ling
YL
Chang
Shun-Jen
SJ
Wang
Jaw-Yuan
JY
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D012709:Serum Albumin
Arch Surg. 2003 Sep;138(9):962-6
12963652
BMJ. 2008 Dec 09;337:a2467
19066258
Dis Colon Rectum. 2004 Dec;47(12):2064-9
15657655
Med Sci Monit. 2006 Jun;12(6):CR240-7
16733481
Eur Surg Res. 2007;39(4):245-50
17457032
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):10-5
12549592
Wien Klin Wochenschr. 2001;113 Suppl 3:32-8
15503618
Jpn J Clin Oncol. 2000 Jan;30(1):12-6
10770562
Clin Chem. 2001 Apr;47(4):624-30
11274010
Semin Cancer Biol. 1999 Apr;9(2):67-81
10202129
Kaohsiung J Med Sci. 2006 Dec;22(12):604-9
17116621
World J Surg. 2005 Aug;29(8):1013-21; discussion 1021-2
15981044
Rev Med Chil. 2004 Jun;132(6):691-700
15332370
Gut. 2002 Jul;51(1):60-4
12077093
J Exp Med. 1965 Mar 1;121:439-62
14270243
Nutr Cancer. 2001;39(2):210-3
11759282
CA Cancer J Clin. 1989 Jan-Feb;39(1):50-7
2492877
Int J Colorectal Dis. 2008 Jun;23(6):601-10
18343931
Dis Colon Rectum. 1999 Jul;42(7):921-9
10411440
J R Coll Surg Edinb. 1998 Jun;43(3):163-8
9654876
Int J Colorectal Dis. 2002 May;17(3):177-84
12049312
J Surg Oncol. 2006 Mar 1;93(3):173-80
16482596
Fukushima J Med Sci. 1994 Jun;40(1):9-17
7988985
J Clin Epidemiol. 1999 Apr;52(4):371-4
10235178
N Engl J Med. 1978 Aug 31;299(9):448-51
683276
Br J Cancer. 2004 Jul 19;91(2):205-7
15213726
Br J Cancer. 1998 Nov;78(10):1346-9
9823977