Prognostic Factors Analysis Of 78 Patients With Colorectal Cancer In Stage IV

Objective:Colorectal cancer remains one of the leading cause of cancer death in the world,both the incident and the death related to colorectal cancer show a improving tendency.Although novel medicines with new mechanism are putting into clinical application,survival rate of 5 years in patients with colorectal cancer in stageⅣis 5% only.This study aimed to disscuss the effect of clinical characteristics and therapy methods on the survival of patients with colorectal cancer in stageⅣ. Methods: 78 patients with colorectal cancer in stageⅣwere evaluated retrospectively. All patients received therapy in First Affiliated Hospital of DalianMedical University during January 2001 to December 2007. Clinical characteristics,such as age, sex, serum HB, ALP, CEA and CA199 value,primary tumor site, primary tumor size, pathologic type, histological grade, stage at the first dignosis,invasional depth of primary tumor and regional lymph node metastases in patients earlier than stageⅣat the first dignosis, the number of metastatic organ,the timelines of metastases,and therapy methods were analyzed in 78 patients with colorectal cancer of stage IV. Kaplan-Meier survival curves were generated by SPSS16.0 software for statistical analysis. Univariate analysis and multivariate Cox model analysis is used to explore the impact factors of prognosis.Results: All patients fulfilled the 6th edition TNM staging with colorectal cancer of International Union Against Cancer (UICC). According to the World Health Organization, the patients were divided into young, middle and old aged groups by the definition of 44-year-old, 60-year-old. Quality assessment of life was determined in accordance with ECOG score standard. In this study,we defined earlier therapy and latter therapy in 78 patients of colorectal cancer ,according to the therapy time of before or after progressing into stage IV.This article involved in oncology therapy (which involved in chemotherapy and molecular targeted therapy)and systemic treatment(which involved in operation,interventional chemotherapy,melt and radiotherapy).Single of survival factor analysis showed that ECOG score(P=0.021,<0.05),invasional depth of primary tumor in patients earlier than stageⅣat the first dignosis(P=0.046,<0.05)and the latter treatmen(tP=0.011,<0.05)were significant difference. No significant difference was showed in clinical characteristics ,such as age, sex, serum HB, ALP, CEA and CA199 value,primary tumor site, primary tumor size, pathologic type, histological grade, stage at the first dignosis,regional lymph node metastases in patients earlier than stageⅣat the first dignosis,the number of metastatic organ,the timelines of metastases(P>0.05),in addition,the earlier therapy was also no statiscally significant(P > 0.05). Univariate analysis and multivariate Cox model analysis is used to explore the impact factors of prognosis. ECOG score(P=0.010,<0.05),Invasional depth of primary tumor in patients earlier than stageⅣat the first dignosi(sP=0.032,<0.05)and comprehensive therapy in patients progressing into stage IV(P=0.041,<0.05) were the independent prognosis factors of stageⅣcolorectal cancer.Conclusion:The median survival time of 78 patients with colorectal cancer in stageⅣwas 16.0 month,and the survival rate of 1,2,3 years was 61.5%,28.2%,17.2% respectively. ECOG score <2,vasional depth of primary tumor <T4 in patients earlier than stageⅣat the first dignosis, local therapy and local therapy in combination with chemotherapy±molecular targeted therapy in patients progressing into stageⅣwere independent factors which benefit for prognosis of patients with colorectal cancer in stage IV.In this study,we suggest that patients with colorectal cancer of stageⅣwill benefit from earlier diagnosis,good body condition and comprehensive therapy.