title: Long-Term Follow-Up of Patients Undergoing Resection of TNM Stage I Colorectal Cancer: An Analysis of Tumour and Host Determinants of Outcome.
abstract: BACKGROUND
  Screening for colorectal cancer improves cancer-specific survival (CSS) through the detection of early-stage disease; however, its impact on overall survival (OS) is unclear. The present study examined tumour and host determinants of outcome in TNM Stage I disease.
  
  
  METHODS
  All patients with pathologically confirmed TNM Stage I disease across 4 hospitals in the North of Glasgow between 2000 and 2008 were included. The preoperative modified Glasgow Prognostic Score (mGPS) was used as a marker of the host systemic inflammatory response (SIR).
  
  
  RESULTS
  There were 191 patients identified, 105 (55 %) were males, 91 (48 %) were over the age of 75 years and 7 (4 %) patients underwent an emergency operation. In those with a preoperative CRP result (n = 150), 35 (24 %) patients had evidence of an elevated mGPS. Median follow-up of survivors was 116 months (minimum 72 months) during which 88 (46 %) patients died; 7 (8 %) had postoperative deaths, 15 (17 %) had cancer-related deaths and 66 (75 %) had non-cancer-related deaths. 5-year CSS was 95 % and OS was 76 %. On univariate analysis, advancing age (p < 0.001), emergency presentation (p = 0.008), and an elevated mGPS (p = 0.012) were associated with reduced OS. On multivariate analysis, only age (HR = 3.611, 95 % CI 2.049-6.365, p < 0.001) and the presence of an elevated mGPS (HR = 2.173, 95 % CI 1.204-3.921, p = 0.010) retained significance.
  
  
  CONCLUSIONS
  In patients undergoing resection for TNM Stage I colorectal cancer, an elevated mGPS was an objective independent marker of poorer OS. These patients may benefit from a targeted intervention.
authors.affiliation: Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK. David.Mansouri@glasgow.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Mansouri
authors.affiliation: Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.|Institute of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, Scotland, UK.
authors.forename: Arfon G
authors.initials: AG
authors.lastname: Powell
authors.affiliation: Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: James H
authors.initials: JH
authors.lastname: Park
authors.affiliation: Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.affiliation: Academic Unit of Colorectal Surgery, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
mesh_terms: D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein