Can composite performance measures predict survival of patients with colorectal cancer?

doi:10.3748/wjg.v20.i42.15805

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World Journal of Gastroenterology

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World J Gastroenterol. Nov 14, 2014; 20(42): 15805-15814
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15805

Table 1 Priorities and weights of performance measures for colorectal cancer using the analytic hierarchy process method

Category	Measure	Description	Global priority¹	Weight²
Category	Measure	Description	Global priority¹	Cohort 1	Cohort 2	Cohort 3
Pre-treatment (PT)	PT1	CRC patients with pre-operative chest X-ray and abdominal ultrasound, CT scan, or MRI	0.144	0.213	0.193	0.213
Pre-treatment (PT)	PT2	Early stage of CRC	0.104	0.154	0.140	0.154
Treatment (T)	T1	CRC patients with history of surgical resection that were checked by colonoscopy or barium enema LGI series with sigmoidoscopy within six months peri-operatively	0.030	0.044	0.040	0.044
	T2	Patients with non-metastatic CRC offered curative resection or neoadjuvant therapy within six weeks of diagnosis	0.057	0.084	0.077	0.084
	T3	Patients with stage I to III CRC who underwent wide surgical resection with a “negative margin”	0.133	0.197	0.179	0.197
	T4	CRC patients who underwent surgery with pathology reports on tumor and node stage	0.116	0.172	0.156	0.172
	T5	Patients with stage I to III CRC with twelve or more lymph nodes examined in pathology reports	0.092	0.136	0.124	0.136
	T6	Patients (< 70 yr) with stage III CRC who received chemotherapy within eight weeks after surgery	0.069		0.093
Follow-up (F)³	F1	CRC patients (stages I–III) survived after five post-operative years	0.101
	F2	RC patients (stages I–III) experienced no local recurrence after five post-operative years	0.082
	F3	CRC patients expired within 30 d after surgery	0.073
Sum of priorities (or weights)			1.001⁴	1.000	1.000	1.000

¹Values from Chung et al[18], 2013;

²Individual weight was derived proportionally from individual global priority;

³Measures from follow-up category were not considered as process measures;

⁴Value due to rounding. Cohort 1: Colon cancer patients, stage < III; Cohort 2: Colon cancer patients, stage III; Cohort 3: Rectal cancer patients. CRC: Colorectal cancer; RC: Rectal cancer; CT: Computed tomography; MRI: Magnetic resonance imaging; LGI: Lower gastrointestinal.

Table 2 Characteristics of patients undergoing colectomy for colorectal adenocarcinoma n (%)

Parameter	Cohort 1	Cohort 2	Cohort 3
Parameter	(n = 1164)	(n = 790)	(n = 1318)
Age (yr)	66.8 ± 13.1	65.4 ± 13.6	64.3 ± 12.8
Sex (M/F)	656 (56.4)/	431 (54.6)/	781 (59.3)/
Sex (M/F)	508 (43.6)	359 (45.4)	537 (40.7)
Location
Rectum	-	-	1318 (100)
Rectosigmoid junction	124 (10.7)	88 (11.1)	-
Sigmoid	440 (37.8)	313 (39.6)	-
Descending	124 (10.7)	72 (9.1)	-
Splenic flexure	35 (3.0)	17 (2.2)	-
Transverse	107 (9.2)	70 (8.9)	-
Hepatic flexure	47 (4.0)	38 (4.8)	-
Ascending	173 (14.9)	118 (14.9)	-
Cecum and appendix	77 (6.6)	44 (5.6)	-
Overlapping	12 (1.0)	7 (0.9)	-
Unspecified	25 (2.1)	23 (2.9)	-
Comorbidity
CCI (0 or 1)	63 (5.4)	26 (3.3)	73 (5.5)
CCI (2)	659 (56.6)	103 (25.7)	531 (40.3)
(> 3)	442 (37.9)	661 (71.0)	714 (54.2)
Grade
Well differentiated	102 (8.8)	46 (5.8)	101 (7.7)
Moderately differentiated	937 (80.5)	640 (81.0)	1072 (81.3)
Poorly differentiated	61 (5.2)	87 (11.0)	89 (6.8)
Un-differentiated	1 (0.1)	-	1 (0.1)
Unspecified	63 (5.4)	17 (2.2)	55 (4.2)
Staging (p)
Stage I	295 (25.3)	-	311 (23.6)
Stage II	869 (74.7)	-	459 (34.8)
Stage III	-	790 (100.0)	548 (41.6)
pT1	133 (11.4)	15 (1.9)	107 (8.1)
pT2	164 (14.1)	37 (4.7)	287 (21.8)
pT3	694 (59.6)	574 (72.7)	719 (54.6)
pT4	162 (13.9)	158 (20.0)	198 (15.0)
Unspecified	11 (0.9)	6 (0.8)	7 (0.5)
pN0	1164 (100)	-	767 (58.2)
pN1	-	505 (63.9)	299 (22.7)
pN2	-	280 (35.4)	246 (18.7)
Unspecified	-	5 (0.6)	6 (0.5)
Lymph node examination	17.7 ± 12.6	19.3 ± 13.9	15.4 ± 10.0
Chemotherapy (yes)	306 (26.3)	600 (75.9)	654 (49.6)
Radiotherapy (yes)	23 (2.0)	32 (4.1)	308 (23.4)
Follow-up months (range)	57.1 ± 20.1	51.3 ± 23.2	54.7 ± 21.3
Follow-up months (range)	(0-84.0)	(0.1-84.0)	(0-83.8)
Five-year survival rate	87.1	73	88.7

Pathological staging and T and N classifications as defined by the American Joint Committee on Cancer, 6^th edition. CCI: Charlson comorbidity index; M/F: Male/Female; p: Pathological.

Table 3 Composite performance scores (mean, range) calculated by different methods

Cohort	All-or-none	70% standard	Equal weight	AHP	PCA
1	0.07 ± 0.26	0.78 ± 0.42	0.74 ± 0.14	0.78 ± 0.14	0 ± 1.00
1	(0.00-1.00)	(0.00-1.00)	(0.29-1.00)	(0.22-1.00)	(-6.44-1.04)
2	NA	0.68 ± 0.47	0.73 ± 0.12	0.73 ± 0.12	0 ± 1.00
2	NA	(0.00-1.00)	(0.25-0.88)	(0.27-0.86)	(-2.03-1.23)
3	0.05 ± 0.21	0.76 ± 0.43	0.73 ± 0.14	0.77 ± 0.13	0 ± 1.00
3	(0.00-1.00)	(0.00-1.00)	(0.14-1.00)	(0.19-1.00)	(-13.13-0.59)

Cohort 1: Colon cancer patients stage < III; Cohort 2: Colon cancer patients stage III; Cohort 3: Rectal cancer patients. AHP: Analytic hierarchy process; NA: Not applicable; PCA: Principal component analysis.

Table 4 Correlation matrix of composite performance scores calculated by different methods

Cohort	Method	All-or-none	70% standard	Equal weight	AHP	PCA
1	All-or-none	1
	70% standard	0.149^b	1
	Equal weight	0.500^b	0.784^b	1
	AHP	0.476^b	0.710^b	0.918^b	1
	PCA	0.288^b	0.664^b	0.819^b	0.853^b	1
2	All-or-none	NA
	70% standard	NA	1
	Equal weight	NA	0.843^b	1
	AHP	NA	0.753^b	0.891^b	1
	PCA	NA	0.436^b	0.502^b	0.823^b	1
3	All-or-none	1
	70% standard	0.125^b	1
	Equal weight	0.429^b	0.794^b	1
	AHP	0.416^b	0.700^b	0.904^b	1
	PCA	0.071^b	0.407^b	0.484^b	0.419^b	1

Cohort 1: Colon cancer patients stage < III; Cohort 2: Colon cancer patients stage III; Cohort 3: Rectal cancer patients.

^bP < 0.01 vs control. AHP: Analytic hierarchy process; NA: Not applicable; PCA: Principal component analysis.

Table 5 Associations between composite performance score and five-year survival by multivariate Cox proportional hazards model

Cohort	Survival	Method
		All-or-none			70% standard			Equal weight			AHP			PCA
		HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value	HR	95%CI	P value
1	OS	0.88	0.45-1.73	NS	0.76	0.59-0.98	0.032	0.32	0.14-0.74	0.007	0.32	0.14-0.73	0.007	0.85	0.78-0.92	< 0.001
	DSS	0.93	0.40-2.20	NS	0.69	0.52-0.91	0.009	0.30	0.12-0.79	0.014	0.28	0.11-0.70	0.006	0.85	0.77-0.95	0.002
	DFS	0.93	0.49-1.80	NS	0.78	0.61-1.01	0.057	0.40	0.17-0.92	0.031	0.36	0.16-0.80	0.013	0.87	0.79-0.95	0.002
2	OS		NA		0.92	0.73-1.17	NS	0.42	0.16-1.08	NS	0.39	0.15-0.98	0.045	0.92	0.83-1.03	NS
	DSS		NA		0.88	0.69-1.13	NS	0.35	0.13-0.94	0.038	0.31	0.12-0.81	0.017	0.90	0.81-1.01	NS
	DFS		NA		0.96	0.76-1.21	NS	0.48	0.19-1.23	NS	0.47	0.19-1.18	NS	0.95	0.83-1.03	NS
3	OS	1.07	0.54-2.13	NS	0.93	0.75-1.16	NS	0.07	0.34-1.46	NS	0.72	0.35-1.49	NS	0.98	0.89-1.08	NS
	DSS	1.33	0.60-2.92	NS	0.9	0.81-1.01	NS	0.61	0.28-1.34	NS	0.66	0.30-1.43	NS	1.00	0.89-1.11	NS
	DFS	1.13	0.58-2.19	NS	0.95	0.75-1.16	NS	0.73	0.35-1.50	NS	0.76	0.37-1.55	NS	0.99	0.90-1.08	NS

Cohort 1: Colon cancer patients stage < III; Cohort 2: Colon cancer patients stage III; Cohort 3: Rectal cancer patients. AHP: Analytic hierarchy process; DFS: Disease-free survival; DSS: Disease-specific survival; NA: Not applicable; OS: Overall survival; PCA: Principal component analysis.

Table 6 Model fit analysis of Akaike’s information criterion values calculated by different methods

Cohort	Survival	Method
Cohort	Survival	All-or-none	70% standard	Equal weight	AHP	PCA
1	OS	12.819	8.544	6.002	5.895	0
	DSS	8.823	2.412	3.047	1.691	0
	DFS	9.406	6.023	4.921	3.434	0
2	OS	NA	14.655	11.914	11.205	0
	DSS	NA	4.593	1.363	0	2.520
	DFS	NA	2.385	0.246	0	1.605
3	OS	0.843	0.483	0	0.105	0.750
	DSS	1.053	0.380	0	0.421	1.507
	DFS	0.617	0.543	0	0.177	0.659

Cohort 1: Colon cancer patients stage < III; Cohort 2: Colon cancer patients stage III; Cohort 3: Rectal cancer patients. Values represent the ∆AIC, where the best model is defined as AIC = 0. AHP: Analytic hierarchy process; AIC: Akaike’s information criterion; DFS: Disease-free survival; DSS: Disease-specific survival; OS: Overall survival; PCA: Principal component analysis.

Citation: Chung KP, Chen LJ, Chang YJ, Chang YJ. Can composite performance measures predict survival of patients with colorectal cancer? World J Gastroenterol 2014; 20(42): 15805-15814
URL: https://www.wjgnet.com/1007-9327/full/v20/i42/15805.htm
DOI: https://dx.doi.org/10.3748/wjg.v20.i42.15805