title: Prognostic factors in patients with non resectable metastatic colorectal cancer in the era of targeted biotherapies: relevance of Köhne's risk classification.
abstract: BACKGROUND
  Köhne's prognostic classification has been previously proposed, based on performance status, alkaline phosphatase level, number of metastatic sites and white blood cells count.
  
  
  OBJECTIVE
  To identify prognostic factors for survival and to assess the validity of Köhne's classification, in the era of targeted biotherapies, in patients treated with chemotherapy for non resectable metastatic colorectal cancer.
  
  
  METHODS
  A total of 290 consecutive patients were retrospectively identified in all gastroenterology units of one French county, between 2004 and 2008. Univariate and multivariate analysis for overall survival were performed using pre-treatment patient characteristics.
  
  
  RESULTS
  All data were available for prognostic categorization in 133 patients. Median survival was 22.1 months. The distribution and median survival for Köhne's prognostic groups were as following: good (n=73; 24.8 months), intermediate (n=35; 24.2 months), and poor (n=25; 7.0 months). The survival difference was significant between good and poor prognostic groups (p<0.01) and between intermediate and poor prognostic groups (p<0.01), but not between good and intermediate prognostic groups (p=0.5). The two independent prognostic factors of survival in multivariate analysis were performance status 0/1 (p<0.01) and white blood cells count<10×10(9)/L (p<0.01).
  
  
  CONCLUSIONS
  The relevance of Köhne's classification is questioned. A simplified score could be validated by largest studies, based on white blood cells count and performance status.
authors.affiliation: Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Reims, Reims, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Desot
authors.forename: Louis
authors.initials: L
authors.lastname: de Mestier
authors.forename: Julien
authors.initials: J
authors.lastname: Volet
authors.forename: Christelle
authors.initials: C
authors.lastname: Delmas
authors.forename: Bruno
authors.initials: B
authors.lastname: Garcia
authors.forename: Patrick
authors.initials: P
authors.lastname: Geoffroy
authors.forename: Naceur
authors.initials: N
authors.lastname: Abdelli
authors.forename: Marielle
authors.initials: M
authors.lastname: Baule
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubroeucq
authors.forename: Eric
authors.initials: E
authors.lastname: Marquis
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D000077544:Panitumumab; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000077544:Panitumumab; D000469:Alkaline Phosphatase; D000068818:Cetuximab