Cause of Death and Clinical Predictors of Survival after Curative Resection for Colon Cancer

Background: Clinical predictors of death and survival in surgical treatment of colon cancer are easily confounded by the modern adjuvant and neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. Methods: Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. The adjusted Cox regression model showed that higher age (1.04 (95% CI: 1.03; 1.05)), male gender (1.37 (1.14; 1.66)), emergency surgery (1.52 (1.21; 1.93)), left vs. right hemicolectomy (1.39 (1.03; 1.87)), and perioperative blood transfusion (1.25 (1.01; 1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58; 0.88)), D2 versus D1 lymph node dissection (0.66 (0.53; 0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06; 0.16), 0.14 (0.11; 0.19), 0.23 (0.18; 0.30) were associated with prolonged survival. Conclusions: In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resection, lack of lymph node dissection, tumour stage, and preoperative blood transfusions are all significant predictors for reduced survival after surgery for colon cancer.