Risk factors for survival after colorectal cancer resection

To describe survival rates and prognostic factors for colorectal cancer (CRC) operated in a district general hospital setting with a special focus on the number of lymph nodes examined.

Between December 2004 and December 2006, a total of 277 CRC patients who underwent surgical treatment in QHSU were included. All patients were followed up intensively from discharge until death or the end of the follow-up (December 31, 2010).

The median follow-up period was 53 months (range, 1-72 months). Overall 3-year survival was 72.9%. In only 11.5% of the specimens were 12 or more lymph nodes retrieved, but this did not affect survival. A multivariate analysis identified that the significant prognostic factors were TNM stage III [adjusted hazard ratio (HR): 5.49; 95%CI: 1.64-18.41], TNM stage IV (adjusted HR: 7.55; 95%CI: 2.12-26.84), tumor histology (adjusted HR: 1.88; 95%CI: 1.16-3.04), hospital stay (adjusted HR: 1.03; 95%CI: 1.00-1.06) and lymph node ratio (LNR) (adjusted HR: 3.92; 95%CI: 1.79-8.55) for stage III.

TNM stage, tumor histology and the length of hospital stay could prominently affect outcome overall. The lymph node count did not have a significant impact on survival, whereas the LNR proved significant for stage III. Nevertheless, a protocol using overall lymph node yield as a surrogate measure for more radical surgery seems warranted to improve the lymph node resected.