Square Oncology & Radiotherapy Centre, Square Hospitals Ltd, Dhaka, Bangladesh.
Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Jpn J Clin Oncol. 2021 Apr 1;51(4):552-559. doi: 10.1093/jjco/hyaa228.
Prognostic factors in colorectal cancer have lesser been evaluated in developing countries. This study aims to determine overall survival and prognostic factors for metastatic colorectal cancer patients who were non-operable and received chemotherapy.
The study retrospectively investigated 67 inoperable metastatic colorectal cancer patients at Square Hospital, Bangladesh. The primary endpoint was overall survival, and the secondary endpoints were prognostic association with factors. Survival probabilities were calculated by non-parametric Kaplan-Meier method and compared by log-rank test. Univariate and multivariable Cox proportional hazard models were implemented to assess the prognostic association.
Median survival of the entire cohort was 14 months (95% confidence interval: 11-25). In multivariable analysis, two prognostic factors were independently associated with survival: Karnofsky performance status and carcinoembryonic antigen. Patients with Karnofsky performance status <70 had significant higher risk of death than those with Karnofsky performance status ≥70 (adjusted hazard ratio 4.25, 95% confidence interval: 2.15-8.39). Higher risk of death was found to be associated with higher carcinoembryonic antigen: adjusted hazard ratio was 1.72 (95% confidence interval: 0.81-3.68) and 2.96 (95% confidence interval: 1.25-7.01) for patients with carcinoembryonic antigen 10-100 and >100 ng/ml, respectively, while comparing with carcinoembryonic antigen <10 ng/ml. The presence of peritoneal metastasis and grade-III tumour significantly worsened the survival in univariate analysis (hazard ratio 2.46, 95% confidence interval: 1.32-4.57 and hazard ratio 1.74, 95% confidence interval: 1.01-3.03, respectively) but not in multivariable analysis (adjusted hazard ratio 1.92, 95% confidence interval: 0.88-4.18 and adjusted hazard ratio 1.25, 95% confidence interval: 0.66-2.36, respectively).
The study reported survival of stage IV colorectal cancer patients undergo chemotherapy and identified that Karnofsky performance status and carcinoembryonic antigen are the poor prognostic factors to this cohort adjusting for other factors.
在发展中国家，结直肠癌的预后因素研究较少。本研究旨在确定不能手术且接受化疗的转移性结直肠癌患者的总生存率和预后因素。
本研究回顾性调查了孟加拉国 Square 医院的 67 例不可手术的转移性结直肠癌患者。主要终点是总生存率，次要终点是与因素相关的预后。通过非参数 Kaplan-Meier 方法计算生存概率，并通过对数秩检验进行比较。采用单因素和多因素 Cox 比例风险模型评估预后相关性。
整个队列的中位生存期为 14 个月（95%置信区间：11-25）。在多因素分析中，有两个预后因素与生存独立相关：卡氏功能状态和癌胚抗原。卡氏功能状态<70 的患者死亡风险明显高于卡氏功能状态≥70 的患者（调整后的危险比 4.25，95%置信区间：2.15-8.39）。发现癌胚抗原越高，死亡风险越高：与癌胚抗原<10ng/ml 相比，癌胚抗原为 10-100ng/ml 的患者调整后的危险比为 1.72（95%置信区间：0.81-3.68），癌胚抗原>100ng/ml 的患者调整后的危险比为 2.96（95%置信区间：1.25-7.01）。腹膜转移和 III 级肿瘤在单因素分析中显著降低生存率（危险比 2.46，95%置信区间：1.32-4.57 和危险比 1.74，95%置信区间：1.01-3.03），但在多因素分析中无统计学意义（调整后的危险比 1.92，95%置信区间：0.88-4.18 和调整后的危险比 1.25，95%置信区间：0.66-2.36）。
本研究报告了接受化疗的 IV 期结直肠癌患者的生存情况，并确定卡氏功能状态和癌胚抗原是该队列的不良预后因素，在调整其他因素后。
