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Mansouri, David; Powell, Arfon; Park, James H.; McMillan, Donald C.; Horgan, Paul G. (2016)
Publisher: Springer
Languages: English
Types: Article
Background\ud \ud 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.\ud \ud Methods\ud \ud 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).\ud \ud Results\ud \ud 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.\ud \ud Conclusions\ud \ud 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.
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    • Age <75 >75 Sex Female Male Mode of presentation Emergency Elective Tumour Site Colon Rectum T-stage 1 2 Venous invasiona Present Absent Differentiation Poor Moderate/well Less than 12 lymph nodes Yes No Date of operation 2001 - 2004 2005 - 2008 Mean OS (months (95% CI)) 65 (56) 50 (44) 49 (43) 66 (57) 1 (1) 114 (99) 69 (60) 46 (40) 37 (32) 78 (68) 28 (27) 75 (73) 3 (3) 112 (97) 60 (52) 55 (48) 52 (45) 63 (55) 0.746 0.040 0.223 0.086 0.382 0.448 0.827 0.520 0.010
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