Multivariate prognostic models for patients with stages i and ii colon carcinoma: A strobe-compliant retrospective cohort study

• Luis F. Oñate Acuña ^[1] ; Roberto Herrera Goepfert ^[2] ; Alejandro Avilés Salas ^[3] ; Carlo C Cortés-González ^[2] ; Sagrario González-Trejo ^[1] ; Jose F. Carrillo ^[4] ; Erika Ruiz García ^[5] ; Francisco J. Ochoa-Carrillo ^[4] ; Vincenzo Aiello Crocifoglio ^[4] ; Claudia M. García-Cuellar ^[6]
  1. [1] Clinical Research Subdirectorate, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
  2. [2] Pathology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
  3. [3] Microscopy Unit, Dirección de Investigación, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
  4. [4] Surgery Subdirectorate, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
  5. [5] Medical Oncology Department, Traslational Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
  6. [6] Basic Research Subdirectorate, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico

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• Localización: Revista de investigación clínica, ISSN 0034-8376, ISSN-e 2564-8896, Vol. 75, Nº. 5, 2023, págs. 259-271
• Idioma: inglés
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  • Colorectal cancer is the most frequent gastrointestinal malignancy worldwide. The value of adjuvant treatment is controversial in Stages I and II. Objective: The aim of this study was to construct post-operative prognostic models applicable to patients with stages I-II colon carcinoma (CC). Methods: This is a retrospective cohort study of patients with Stage I-II CC treated over a 25-year period. Exposure was defined as clinical, histopathological, and immunohistochemical factors (including CDX2 and MUC2 expression). Patients were randomly allocated to either a “modeling set” or a “validation set”. Factors associated with recurrence, disease-free survival (DFS), and overall survival (OS) were defined in the “modeling set”. Their performances were tested in the “validation set”. Results: From a total of 556 recruited patients, 339 (61%) were allocated to the “modeling set” and 217 (39%) to the “validation set”. Three models explaining recurrence, DFS, and OS were described. Tumor location in the left colon (Hazards ratio [HR] = 1.57; 95% Confidence interval [CI] 0.99-2.48), lymphocyte (HR = 0.46; 96% CI 0.27-0.88) and monocyte (HR = 0.99; 95% CI 0.99-1) counts, neutrophil/platelet ratio (HR = 1.3; 95% CI 0.74-2.3, and HR = 2.3; 95% CI 1.3-4.1; for second and third category, respectively), albumin/monocyte ratio (HR = 0.43; 95% CI 0.21-0.87), and microscopic residual disease after surgery (HR = 8.7; 95% CI 3.1-24) were independently associated with OS. T classification and expression of CDX2 and/or MUC2 were not independently associated with recurrence or prognosis. Conclusion: These models are simple and readily available, and distinguish the risk and prognosis in patients with CC stages I and II; these models require cheaper processes than the use of more sophisticated molecular biology techniques. They may guide either the need for adjuvant therapy versus post-operative surveillance only, as well as aid in the design of clinical trials. (REV INVEST CLIN. 2023;75(5):259-71)