Xynos Ioannis D, Kavantzas Nicolaos, Tsaousi Smaro, Zacharakis Michalis, Agrogiannis George, Kosmas Christos, Lazaris Andreas, Sarantonis John, Sougioultzis Stavros, Tzivras Dimitrios, Polyzos Aris, Patsouris Efstratios S, Tsavaris Nikolas
Medical Oncology, Propedeutic, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 7, 11527 Athens, Greece.
ISRN Gastroenterol. 2013 Jun 4;2013:490578. doi: 10.1155/2013/490578. Print 2013.
Objective. To evaluate the prognostic significance of microscopically assessed DNA ploidy and other clinical and laboratory parameters in stage IV colorectal cancer (CRC). Methods. 541 patients with histologically proven stage IV CRC treated with palliative chemotherapy at our institution were included in this retrospective analysis, and 9 variables (gender, age, performance status, carcinoembryonic antigen, cancer antigen 19-9, C-Reactive Protein (CRP), anaemia, hypoalbuminaemia, and ploidy (DNA Index)) were assessed for their potential relationship to survival. Results. Mean survival time was 12.8 months (95% confidence interval (CI) 12.0-13.5). Multivariate analysis revealed that DNA indexes of 2.2-3.6 and >3.6 were associated with 2.94 and 4.98 times higher probability of death, respectively, compared to DNA index <2.2. CRP levels of >15 mg/dL and 5-15 mg/dL were associated with 2.52 and 1.72 times higher risk of death, respectively. Hazard ratios ranged from 1.29 in patients mild anaemia (Hb 12-13.5 g/dL) to 1.88 in patients with severe anaemia (Hb < 8.5 g/dL). Similarly, the presence of hypoalbuminaemia (albumin < 5 g/dL) was found to confer 1.41 times inferior survival capability. Conclusions. Our findings suggest that patients with stage IV CRC with low ploidy score and CRP levels, absent or mild anaemia, and normal albumin levels might derive greatest benefit from palliative chemotherapy.
目的。评估显微镜下评估的DNA倍性及其他临床和实验室参数在IV期结直肠癌（CRC）中的预后意义。方法。本回顾性分析纳入了541例在我院接受姑息化疗且组织学确诊为IV期CRC的患者，评估了9个变量（性别、年龄、体能状态、癌胚抗原、癌抗原19-9、C反应蛋白（CRP）、贫血、低白蛋白血症和倍性（DNA指数））与生存的潜在关系。结果。平均生存时间为12.8个月（95%置信区间（CI）12.0 - 13.5）。多因素分析显示，与DNA指数<2.2相比，DNA指数为2.2 - 3.6和>3.6的患者死亡概率分别高2.94倍和4.98倍。CRP水平>15mg/dL和5 - 15mg/dL的患者死亡风险分别高2.52倍和1.72倍。危险比范围从轻度贫血（血红蛋白12 - 13.5g/dL）患者的1.29到重度贫血（血红蛋白<8.5g/dL）患者的1.88。同样，发现存在低白蛋白血症（白蛋白<5g/dL）的患者生存能力低1.41倍。结论。我们的研究结果表明，IV期CRC患者若倍性评分和CRP水平低、无贫血或轻度贫血且白蛋白水平正常，可能从姑息化疗中获益最大。
