J M Quintana1,2, N González1,2, S Lázaro3, M Baré2,4, N Fernández-de-Larrea5,6, M Redondo2,7, E Briones8, A Escobar2,9, C Sarasqueta2,10, S García-Gutierrez1,2, A Antón-Ladislao1,2. 1. Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain. 2. Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Spain. 3. Servicio de Cirugía General, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain. 4. Unidad de Epidemiología Clínica, Corporacio Parc Taulí, Sabadell, Barcelona, Spain. 5. Centro Nacional de Epidemiología, ISCIII, Madrid, Spain. 6. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 7. Unidad de Investigación, Hospital Costa del Sol, Málaga, Spain. 8. Distrito AP Sevilla, UDG Salud Pública, Sevilla, Spain. 9. Unidad de Investigación, Hospital U. Basurto, Bilbao, Bizkaia, Spain. 10. Unidad de Investigación, Hospital U. Donostia/BIONOSTIA, Donostia-San Sebastian, Gipuzkoa, Spain.
Abstract
AIM: Tools are needed to aid in the assessment of the prognosis of patients with rectal cancer regarding the risk of medium-term mortality. The aim of this study was to develop and validate clinical prediction rules for 1- and 2-year mortality in patients undergoing surgery for rectal cancer. METHOD: A prospective cohort study of patients diagnosed with rectal cancer who underwent surgery was carried out. The main outcomes were mortality at 1 and 2 years after surgery. Background, clinical parameters and diagnostic test findings were evaluated as possible predictors. Multivariable survival models were used in the statistical analyses. RESULTS: Predictors of 1-year mortality were being a current smoker [hazard ratio (HR) 4.98], having a Charlson index adjusted by age > 5 (HR 2.61), the presence of vascular, perineural or lymphatic invasion (HR 3.30), the presence of residual tumour at the operation (R-stage) (HR 8.64) and TNM stage (HR for TNM IV 5.10) [concordance index (C-index) 0.799 (95% CI: 0.71-0.89)]. Age greater than 80 years (HR 2.19), being a current smoker (HR 2.20), the pre-intervention haemoglobin level (HR 2.02), need for blood transfusion (HR 2.12), vascular, perineural or lymphatic invasion (HR 2.59), R-stage of the operation (HR 6.13) and TNM stage (HR for TNM IV 4.43) were predictors of 2-year mortality [C-index 0.779 (0.718-0.840)]. Adjuvant chemotherapy was an additional predictor at both outcome durations. CONCLUSION: These clinical parameters show good predictive values and are easy and quick-to-use tools to help in clinical decision making. Colorectal Disease
AIM: Tools are needed to aid in the assessment of the prognosis of patients with rectal cancer regarding the risk of medium-term mortality. The aim of this study was to develop and validate clinical prediction rules for 1- and 2-year mortality in patients undergoing surgery for rectal cancer. METHOD: A prospective cohort study of patients diagnosed with rectal cancer who underwent surgery was carried out. The main outcomes were mortality at 1 and 2 years after surgery. Background, clinical parameters and diagnostic test findings were evaluated as possible predictors. Multivariable survival models were used in the statistical analyses. RESULTS: Predictors of 1-year mortality were being a current smoker [hazard ratio (HR) 4.98], having a Charlson index adjusted by age > 5 (HR 2.61), the presence of vascular, perineural or lymphatic invasion (HR 3.30), the presence of residual tumour at the operation (R-stage) (HR 8.64) and TNM stage (HR for TNM IV 5.10) [concordance index (C-index) 0.799 (95% CI: 0.71-0.89)]. Age greater than 80 years (HR 2.19), being a current smoker (HR 2.20), the pre-intervention haemoglobin level (HR 2.02), need for blood transfusion (HR 2.12), vascular, perineural or lymphatic invasion (HR 2.59), R-stage of the operation (HR 6.13) and TNM stage (HR for TNM IV 4.43) were predictors of 2-year mortality [C-index 0.779 (0.718-0.840)]. Adjuvant chemotherapy was an additional predictor at both outcome durations. CONCLUSION: These clinical parameters show good predictive values and are easy and quick-to-use tools to help in clinical decision making. Colorectal Disease
Authors: Javier Mar; Ane Anton-Ladislao; Oliver Ibarrondo; Arantzazu Arrospide; Santiago Lázaro-Aramburu; Nerea Gonzalez; Marisa Bare; Antonio Escobar; Maximino Redondo; José M Quintana Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584