Colorectal Cancer
Copyright ©2006 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 28, 2006; 12(12): 1849-1858
Published online Mar 28, 2006. doi: 10.3748/wjg.v12.i12.1849
Table 1 Patient characteristics
Adjuvant radiochemotherapy n (%)Neoadjuvant radiochemotherapy n (%)All n (%)
Gender
Female148 (63.5)38 (71.7)186 (65.0)
Male85 (36.5)15 (28.3)100 (35.0)
Age
≤Median age of 62 yr134 (57.5)32 (60.4)166 (58.0)
> Median age of 62 yr99 (42.5)21 (39.6)120 (42.0)
Tumor location
Upper third35 (15.1)0 (0.0)35 (12.2)
Middle third100 (42.9)23 (43.4)123 (43.0)
Lower third87 (37.3)25 (47.2)112 (39.2)
Not known11 (4.7)5 (9.4)16 (5.6)
Surgical Resection
Anterior (LAR)133 (56.8)13 (24.6)146 (51.0)
Abdominoperineal (APR)100 (43.2)40 (75.4)140 (49.0)
R status
R0197 (84.5)37 (69.8)234 (81.8)
R117 (7.3)5 (9.4)22 (7.7)
R24 (1.8)2 (3.8)6 (2.1)
not known15 (6.4)9 (17.0)24 (8.4)
Stage
II75 (32.2)17 (32.1)92 (32.2)
III158 (67.8)36 (67.9)194 (67.8)
N stage
N074 (31.8)17 (32.1)91 (31.8)
N181 (34.8)27 (50.9)108 (37.8)
N278 (33.4)9 (17.0)87 (30.4)
Grading
G I11 (4.7)9 (17.0)20 (7.0)
G II161 (69.1)29 (54.7)190 (66.5)
G III44 (18.9)9 (17.0)53 (18.5)
Not known17 (7.3)6 (11.3)23 (8.0)
CEA
< 3 ng/mL102 (43.8)16 (30.2)118 (41.3)
≥ 3 ng/mL102 (43.8)16 (30.2)118 (41.3)
Not known29 (12.4)21 (39.6)50 (17.4)
RTOG
RTOG 096 (41.2)30 (56.6)126 (44.1)
RTOG I75 (32.2)14 (26.4)89 (31.1)
RTOG II46 (19.7)9 (17.0)55 (19.2)
RTOG III13 (5.6)0 (0.0)13 (4.6)
RTOG IV3 (1.3)0 (0.0)3 (1.0)
RTOG V0 (0.0)0 (0.0)0 (0.0)
Table 3 Survival rates and results of uni- and multivariate analysis (patient-related variables)
OAS (%)CSS (%)DFS(%)LRS (%)DRS (%)
All stages II & III5 yr / 10 yr:47.0 / 36.060.0 / 52.041.4 /34.967.2 / 65.784.3 / 84.3
at risk (5 yr / 10 yr):78 / 3481 / 3669 / 3472 / 4674 / 34
median survival:1602996
Gender
Male5 yr / 10 yr:49.2 / 36.364.9 / 56.824.7 / 12.973.1 / 73.185.1 / 85.1
Female5 yr / 10 yr:43.2 / 37.051.7 / 44.321.0 / 8.056.8 / 53.083.2 / 83.2
uni- / multivariate: P =0.93 / NS0.16 / NS0.17 / NS0.01 / 0.0180.66 / NS
multivariate risk ratio:male: 0.75
(CI 0.59 – 0.95)
Age
< 62 yr5 yr / 10 yr:52.2 / 42.062.0 / 55.831.1 / 16.065.3 / 63.485.9 / 85.9
> 62 yr5 yr / 10 yr:41.0 / 27.057.1 / 42.613.6 / 5.170.4 / 70.480.2 / 80.2
*Median ageuni- / multivariate: P =0.02 / NS0.22 / 0.005< 0.01 / NS0.47 / NS0.59 / NS
multivariate risk ratio:< 61 yr: 0.48
(CI 0.28 – 0.80)
Staging
II5 yr / 10 yr:57.0 / 49.965.8 / 62.553.3 / 45.575.1 / 75.185.5 / 85.5
III5 yr / 10 yr:42.6 / 30.257.2 / 47.436.3 / 28.763.3 / 61.083.8 / 83.8
uni- / multivariate: P =0.02 / NS0.09 / 0.0090.02 / NS0.06 / (0.07)0.7 / NS
multivariate risk ratio:stage II: 0.45stage II: 0.79
(CI 0.21 – 0.84)(CI 0.59 – 1.03)
Grading
II5 yr / 10 yr:50.6 / 39.762.0 / 55.149.3 / 41.773.3 / 70.786.8 / 86.8
III5 yr / 10 yr:40.7 / 36.655.3 / 49.823.3 / 23.358.8 / 58.864.4 / 64.4
uni- / multivariate: P =0.023 / (0.06)0.07 / NS< 0.01 / NS0.04 / NS< 0.01 / 0.04
multivariate risk ratio:G III: 1.68G III: 2.87
(CI 0.97 – 2.78)(CI 1.08 – 7.01)
Table 2 Anemia and hemoglobin values during radiotherapy (subgroup analysis of 192 patients)
Adjuvant radiochemotherapy n (%)Neoadjuvant radiochemotherapy n (%)All n (%)
Anemia before RT
No78 (47.6)14 (50.0)92 (47.9)
Yes86 (52.4)14(50.0)100 (52.1)
Anemia after RT
No102 (62.2)8 (28.6)110 (57.3)
Yes62 (37.8)20 (71.4)82 (42.7)
Hemoglobin during RT
Hb increase106 (64.6)10 (35.7)116 (60.4)
Hb decrease58 (35.4)18 (64.3)76 (39.6)
Table 6 Anemia and hemoglobin increase versus decrease during radiotherapy (subgroup analysis of 199 patients with documented hemoglobin values before and after radiotherapy)
OAS (%)CSS (%)DFS(%)LRS (%)DRS (%)
Anemia before RCT
No5 yr / 10 yr:44.6 / 31.466.4 / 66.441.5 / 33.776.6 / 76.674.9 / 74.9
Yes5 yr / 10 yr:49.5 / 47.255.4 / 45.648.5 / 39.261.5 / 59.688.1 / 88.1
uni- / multivariate: P =0.39 / NS0.14 / NS0.83 / 0.040.04 / NS0.01 / NS
multivariate risk ratio:anemia present: 0.76
(CI 0.57 – 0.99)
Anemia after RCT
No5 yr / 10 yr:47.5 / 34.057.4 / 48.442.5 / 34.787.6 / 87.662.7 / 60.7
Yes5 yr / 10 yr:47.0 / 41.564.7 / 59.339.6 / 35.980.0 / 80.073.0 / 73.0
uni- / multivariate: P =0.76 / NS0.56 / NS0.83 / NS0.12 / NS0.06 / NS
multivariate risk ratio:
Hemoglobin (Hb) increase or decrease during RT
Hb increase5 yr / 10 yr:67.7 / 59.358.8 / 51.445.2 / 45.283.8 / 83.862.8 / 62.8
Hb decrease5 yr / 10 yr:35.3 / 35.338.7 / 33.936.2 / 36.273.9 / 73.975.9 / 75.9
uni- / multivariate: P =< 0.01 / NS< 0.01 / NS0.08 / 0.040.38 / NS0.79 / NS
multivariate risk ratio:Hb decrease: 1.97
(CI 1.02 – 3.43)
Table 7 Anemia and patient characteristics.
Hb decreaseduring RTn (%)P value
Age
≤ 621yr42 (42.9)0.31
> 621yr32 (35.6)
Stage
II18 (30.0)0.07
III56 (43.8)
Other serious diagnoses
No38 (35.2)0.17
Yes36 (45.0)
BMI
≤ 24.2244 (50.0)0.03
> 24.2218 (26.5)
Radiochemotherapy
Postoperative56 (35.0)0.03
Preoperative18 (64.3)
Surgical Resection
LAR42 (38.2)0.96
APR28 (37.8)
R status
R 024 (30.8)0.04
R 1/210 (55.6)
Side effects
RTOG 08 (80.0)0.27
RTOG I / II62 (38.8)
RTOG III / IV4 (22.2)
Table 5 Results of uni- and multivariate analysis (other variables)
OASCSSDFSLRSDRS
N stage
uni- / multivariate: P =0.009 / NS0.05 / NS0.06 / NS0.09 / NS0.15 / NS
CEA
uni- / multivariate: P =< 0.001 / 0.007< 0.001 / NS< 0.001 / 0.001< 0.001 / NS0.55 / 0.055
multivariate risk ratio:CEA increase: 1.37CEA increase: 3.21CEA decrease: 0.91
(CI 1.09 – 1.73)(CI 1.61 – 6.82)(CI 0.76 – 1.00)
CA 19-9
uni- / multivariate: P =< 0.001 / NS0.033 / NS0.22 / NS0.79 / NS0.62 / NS
Tumor location
uni- / multivariate: P =0.34 / NS0.43 / NS0.4 / NS0.83 / NS0.37 / NS
Adherence to adjacent structures
uni- / multivariate: P =< 0.001 / NS0.004 / NS< 0.001 / NS0.13 / NS0.019 / NS
BMI before RT
uni- / multivariate: P =0.47 / NS0.55 / NS0.83 / NS0.83 / NS0.15 / NS
Smoking
uni- / multivariate: P =0.79 / NS0.49 / NS0.71 / NS0.22 / NS0.31 / NS
Hkt before vs after RT
uni- / multivariate: P =0.047 / NS0.35 / NS0.31 / NS0.87 / NS0.99 / NS
LDH before vs after RT
uni- / multivariate: P =0.32 / NS0.69 / NS0.77 / NS0.37 / NS0.21 / NS
Table 4 Survival rates and results of uni- and multivariate analysis (treatment-related variables)
OAS (%)CSS (%)DFS(%)LRS (%)DRS (%)
Adjuvant therapy
Postop RCT5 yr / 10 yr:47.6 / 35.659.0 / 48.440.2 / 34.0%66.1 / 64.182.2 / 82.2
Preop RCT5 yr / 10 yr:43.9 / 38.062.6 / 62.645.4 / 39.369.8 / 69.892.8 / 92.8
uni- / multivariate: P =0.82 / NS0.56 / NS0.61 / NS0.96 / NS0.12 / NS
Protocol
NIH5 yr / 10 yr:60.7 / 45.272.5 / 59.449.8 / 44.284.1 / 84.173.2 / 73.2
ARO5 yr / 10 yr:26.9 / 21.545.6 / 36.524.5 / 16.367.6 / 67.664.0 / 64.0
uni- / multivariate: P =< 0.001 / NS0.003 / 0.0040.002 / NS0.024 / NS0.57 / NS
multivariate risk ratio:ARO: 2.66
(CI 1.37 – 5.21)
Surgeryrisk ratio:
LAR5 yr / 10 yr:36.4 / 25.949.5 / 41.127.8 / 22.764.7 / 64.781.3 / 81.3
APR5 yr / 10 yr:35.2 / 26.046.7 / 39.927.6 / 22.952.4 / 51.186.4 / 86.4
uni- / multivariate: P =0.4 / NS0.51 / NS0.27 / NS0.015 / 0.0390.6 / NS
multivariate risk ratio:LAR: 1.3
(CI 1.01 – 1.60)
R status
R05 yr / 10 yr:53.2 / 40.364.2 / 55.145.6 / 39.566.2 / 64.591.2 / 91.2
R1 or R25 yr / 10 yr:14.2 / 14.220.7 / 20.717.3 / 17.362.9 / 62.951.2 / 51.2 5
uni- / multivariate: P =< 0.001 / NS0.011 / (0.09)< 0.001 / 0.0260.95 / NS< 0.001 / NS
multivariate risk ratio:R1/R2: 1.65R1/R2: 3.45
(CI 0.91 – 3.10)(1.56 – 7.96)