Risk groups defined by Recursive Partitioning Analysis of patients with colorectal adenocarcinoma treated with colorectal resection

BMC Medical Research Methodology

Mei-Shu Lai⁴  Kuo-Piao Chung⁵  Yao-Jen Chang¹  Li-Ju Chen²  Yun-Jau Chang³ 

[1]Department of Surgery, Taipei Branch, Buddhist Tzu Chi General Hospital, Taipei, Taiwan

[2]Department of Ophthalmology, HepingFuyou Branch, Taipei City Hospital, Taipei, Taiwan

[3]Department of General Surgery, National Taiwan University Hospital, Taipei, Taiwan

[4]Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

[5]Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan

关键词: Survival Analysis;    Colorectal Cancer;    Recursive Partitioning Analysis;   

Others  :  1136853
DOI  :  10.1186/1471-2288-12-2

 received in 2011-06-16, accepted in 2012-01-03,  发布年份 2012

【 摘 要 】

Background

To define different prognostic groups of surgical colorectal adenocarcinoma patients derived from recursive partitioning analysis (RPA).

Methods

Ten thousand four hundred ninety four patients with colorectal adenocarcinoma underwent colorectal resection from Taiwan Cancer Database during 2003 to 2005 were included in this study. Exclusion criteria included those patients with stage IV disease or without number information of lymph nodes. For the definition of risk groups, the method of classification and regression tree was performed. Main primary outcome was 5-year cancer-specific survival.

Results

We identified six prognostic factors for cancer-specific survival, resulting in seven terminal nodes. Four risk groups were defined as following: Group 1 (mild risk, 1,698 patients), Group 2 (moderate risk, 3,129 patients), Group 3 (high risk, 4,605 patients) and Group 4 (very high risk, 1,062 patients). The 5-year cancer-specific survival for Group 1, 2, 3, and 4 was 86.6%, 62.7%, 55.9%, and 36.6%, respectively (p < 0.001). Hazard ratio of death was 2.13, 5.52 and 10.56 (95% confidence interval 1.74-2.60, 4.58-6.66 and 8.66-12.9, respectively) times for Group 2, 3, and 4 as compared to Group 1. The predictive capability of these grouping was also similar in terms of overall and progression-free survival.

Conclusion

The use of RPA offered an alternative grouping method that could predict the survival of patients who underwent surgery for colorectal adenocarcinoma.

【 授权许可】

   
2012 Chang et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Chung KP, Chang YJ, Lai MS, Kuo RN, Cheng SH, Chen LT, Tang R, Liu TW, Shieh MJ: Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan. BMC Health Serv Res 2010, 10:27. BioMed Central Full Text
• [2]Schneider EC, Epstein AM, Malin JL, Kahn KL, Emanuel EJ: Developing a system to assess the quality of cancer care: ASCO's national initiative on cancer care quality. J Clin Oncol 2004, 22(15):2985-2991.
• [3]Park CK, Lee SH, Han JH, Kim CY, Kim DW, Paek SH, Kim DG, Heo DS, Kim IH, Jung HW: Recursive partitioning analysis of prognostic factors in WHO grade III glioma patients treated with radiotherapy or radiotherapy plus chemotherapy. BMC Cancer 2009, 9:450. BioMed Central Full Text
• [4]Lamborn KR, Chang SM, Prados MD: Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 2004, 6(3):227-235.
• [5]Langendijk JA, Slotman BJ, van der Waal I, Doornaert P, Berkof J, Leemans CR: Risk-group definition by recursive partitioning analysis of patients with squamous cell head and neck carcinoma treated with surgery and postoperative radiotherapy. Cancer 2005, 104(7):1408-1417.
• [6]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45(6):613-619.
• [7]Zlobec I, Steele R, Nigam N, Compton CC: A predictive model of rectal tumor response to preoperative radiotherapy using classification and regression tree methods. Clin Cancer Res 2005, 11(15):5440-5443.
• [8]Hendifar A, Yang D, Lenz F, Lurje G, Pohl A, Lenz C, Ning Y, Zhang W, Lenz HJ: Gender disparities in metastatic colorectal cancer survival. Clin Cancer Res 2009, 15(20):6391-6397.
• [9]Jessup JM, Stewart A, Greene FL, Minsky BD: Adjuvant chemotherapy for stage III colon cancer - Implications of race/ethnicity, age, and differentiation. JAMA 2005, 294(21):2703-2711.
• [10]Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D: A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Annals of Epidemiology 2007, 17(8):584-590.
• [11]Chen SL, Bilchik AJ: More extensive nodal dissection improves survival for stages I to III of colon cancer - a population-based study. Ann Surg 2006, 244(4):602-610.
• [12]Namm J, Ng M, Roy-Chowdhury S, Morgan JW, Lum SS, Wong JH: Quantitating the impact of stage migration on staging accuracy in colorectal cancer. J Am Coll Surg 2008, 207(6):882-887.
• [13]Chang YJ, Chen LJ, Chang YJ, Chung KP, Lai MS: Application of Propensity Score Model to Examine The Prognostic Significance of Lymph Node Number as a Care Quality Indicator. Surgl Oncol 2012, in press.
• [14]Mehrkhani F, Nasiri S, Donboli K, Meysamie A, Hedayat A: Prognostic factors in survival of colorectal cancer patients after surgery. Colorectal Dis 2009, 11(2):157-161.
• [15]Staib L, Link KH, Blatz A, Beger HG: Surgery of colorectal cancer: Surgical morbidity and five- and ten-year results in 2400 patients - Monoinstitutional experience. World J Surg 2002, 26(1):59-66.
• [16]Gunderson LL, Sargent DJ, Tepper JE, Wolmark N, O'Connell MJ, Begovic M, Allmer C, Colangelo L, Smalley SR, Haller DG, et al.: Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: A pooled analysis. J Clin Oncol 2004, 22(10):1785-1796.
• [17]Kelly SB, Mills SJ, Bradburn DM, Ratcliffe AA, Borowski DW: Effect of the circumferential resection margin on survival following rectal cancer surgery. Br J Surg 2011.
• [18]Martenson JA, Willett CG, Sargent DJ, Mailliard JA, Donohue JH, Gunderson LL, Thomas CR, Fisher B, Benson AB, Myerson R, et al.: Phase III study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: Results of intergroup protocol 0130. J Clin Oncol 2004, 22(16):3277-3283.
• [19]Cunningham D, Humblet Y, Siena S, Khayat D, Bleiberg H, Santoro A, Bets D, Mueser M, Harstrick A, Verslype C, et al.: Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004, 351(4):337-345.
• [20]Chen HX, Mooney M, Boron M, Vena D, Mosby K, Grochow L, Jaffe C, Rubinstein L, Zwiebel J, Kaplan RS: Phase II multicenter trial of bevacizumab plus fluorouracil and leucovorin in patients with advanced refractory colorectal cancer: An NCI Treatment Referral Center trial TRC-0301. J Clin Oncol 2006, 24(21):3354-3360.
• [21]Sanoff HK, Sargent DJ, Green EM, McLeod HL, Goldberg RM: Racial Differences in Advanced Colorectal Cancer Outcomes and Pharmacogenetics: A Subgroup Analysis of a Large Randomized Clinical Trial. Amer Soc Clinical Oncology 2009 2009, 4109-4115.
• [22]Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier J: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006, 355(11):1114-1123.
• [23]Mamounas E, Wieand S, Wolmark N, Bear HD, Atkins JN, Song K, Jones J, Rockette H: Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project adjuvant studies (C-01, C-02, C-03, and C-04). J Clin Oncol 1999, 17(5):1349-1355.
• [24]Benson AB, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, et al.: American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004, 22(16):3408-3419.
• [25]Bilimoria KY, Stewart AK, Edge SB, Ko CY: Lymph node examination rate, survival rate, and quality of care in colon cancer. JAMA 2008, 299(8):896-896.
• [26]Derwinger K, Carlsson G, Gustavsson B: Stage migration in colorectal cancer related to improved lymph node assessment. Eur J Surg Oncol 2007, 33(7):849-853.
• [27]George S, Primrose J, Talbot R, Smith J, Mullee M, Bailey D, du Boulay C, Jordan H: Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists. Br J Cancer 2006, 95(7):841-847.
• [28]Scott N: Radiotherapy and rectal cancer. J Pathol 2002, 197(1):4-5.