title: Colon cancer with unresectable synchronous metastases: the AAAP scoring system for predicting the outcome after primary tumour resection.
abstract: OBJECTIVE
  The aim of this study was to develop a prognostic scoring system to predict the outcome of patients with unresectable metastatic colon cancer who received primary colon tumour resection.
  
  
  METHODS
  Patients with confirmed metastatic colon cancer treated at the Peking University Cancer Hospital between 2003 and 2012 were reviewed retrospectively. The correlation of clinicopathological factors with overall survival was analysed using the Kaplan-Meier method and the log-rank test. Independent prognostic factors were identified using a Cox proportional hazards regression model and were then combined to form a prognostic scoring system.
  
  
  RESULTS
  A total of 110 eligible patients were included in the study. The median survival time was 10.4 months and the 2-year overall survival (OS) rate was 21.8%. Age over 70 years, an alkaline phosphatase (ALP) level over 160 IU/l, ascites, a platelet/lymphocyte ratio (PLR) above 162 and no postoperative therapy were independently associated with a shorter OS in multivariate analysis. Age, ALP, ascites and PLR were subsequently combined to form the so-called AAAP scoring system. Patients were classified into high, medium and low risk groups according to the score obtained. There were significant differences in OS between each group (P < 0.001).
  
  
  CONCLUSIONS
  Age, ALP, ascites, PLR and postoperative therapy were independent prognostic factors for survival of patients with metastatic colonic cancer who underwent primary tumour resection. The AAAP scoring system may be a useful tool for surgical decision making.
authors.affiliation: Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Li
authors.affiliation: Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
authors.forename: Y F
authors.initials: YF
authors.lastname: Peng
authors.affiliation: Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
authors.forename: C Z
authors.initials: CZ
authors.lastname: Du
authors.affiliation: Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Gu
mesh_terms: D000367:Age Factors; D000368:Aged; D000469:Alkaline Phosphatase / Q000032:analysis; D001201:Ascites / Q000473:pathology; D014408:Biomarkers, Tumor / Q000097:blood*; D003082:Colectomy / Q000401:mortality*; D003106:Colon / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D000469:Alkaline Phosphatase
keywords: Metastatic colorectal cancer; primary tumour resection; prognosis; risk ranking