title: Colon cancer: association of histopathological parameters and patients' survival with clinical presentation.
abstract: Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.
authors: Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Oncology Research Center, Landspitali - University Hospital, Reykjavik, Iceland; The Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.
authors: Kristin K
authors: KK
authors: Alexiusdottir
authors: Petur
authors: P
authors: Snaebjornsson
authors: Laufey
authors: L
authors: Tryggvadottir
authors: Larus
authors: L
authors: Jonasson
authors: Elinborg J
authors: EJ
authors: Olafsdottir
authors: Einar Stefan
authors: ES
authors: Björnsson
authors: Pall Helgi
authors: PH
authors: Möller
authors: Jon G
authors: JG
authors: Jonasson
mesh_terms: D015746:Abdominal Pain / Q000473:pathology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000473:pathology* / Q000503:physiopathology; D003106:Colon / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007055:Iceland; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D020556:Neutrophil Infiltration; D009780:Occult Blood; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D006454:Hemoglobins
keywords: Colon cancer; anemia; pathology; survival; symptoms; tumor grade; tumor type