Prognostic Factors for Metastatic Colorectal Cancer after First-line Chemotherapy with FOLFOX-4 or FOLFIRI Regimen

Jae Hyun Kim; Pyoung Rak Choi; Seun Ja Park; Moo In Park; Won Moon; Sung Eun Kim; Gyu Won Lee

doi:10.4166/kjg.2014.63.4.209

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Kim, Choi, Park, Park, Moon, Kim, and Lee: Prognostic Factors for Metastatic Colorectal Cancer after First-line Chemotherapy with FOLFOX-4 or FOLFIRI Regimen

Original Article

Korean J Gastroenterol 2014;63(4):209-215.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.4.209

Prognostic Factors for Metastatic Colorectal Cancer after First-line Chemotherapy with FOLFOX-4 or FOLFIRI Regimen

Jae Hyun Kim, Pyoung Rak Choi, Seun Ja Park, Moo In Park, Won Moon, Sung Eun Kim, Gyu Won Lee

Department of Gastroenterology, Kosin University Gospel Hospital, Busan, Korea

Correspondence to: Seun Ja Park, Department of Gastroenterology, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea. Tel: +82-51-990-5061, Fax: +82-51-990-5055, E-mail: parksj6406@daum.net

Received 31 December 2013 Revised 26 February 2013 Accepted 27 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Information on prognostic factors for metastatic colorectal cancer is an important basis for planning the treatment and predicting the outcomes of the patients; however, it has not been well established. The aim of this study was to identify factors that predict results of chemotherapy and to establish a plan for treatment of patients whose tumors are inoperable due to metastatic colorectal cancer.

Methods

We conducted a retrospective review of records from 75 patients treated for colorectal cancer in Kosin University Gospel Hospital, from October 2004 to September 2008. Patients with inoperable tumors due to metastasis at the time of diagnosis who were treated with oxaliplatin or irinotecan as the first-line treatment were included in this study. We investigated the factors that might have an effect on overall survival.

Results

A total of 75 patients were included in this study. Results of univariate analysis showed that hemoglobin (Hb) ≥10 g/dL at the time of diagnosis, no increase in CEA on the follow-up examination after chemotherapy, chemotherapy plus surgery, and better response to chemotherapy were significant prognostic factors. Results of multivariate analysis showed that Hb ≥10 g/dL at the time of diagnosis (p＜0.001), surgery after chemotherapy (p=0.001), and better response to chemotherapy (p=0.014) were significant prognostic factors.

Conclusions

In this study, Hb ≥10 g/dL at the time of diagnosis, surgery after chemotherapy, and better response to chemotherapy were significant prognostic factors for metastatic colorectal cancer.

Keywords: Colorectal neoplasms, Prognostic factors, Chemotherapy

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Fig. 1.

Overall survival according to whether or not surgery was performed after initial chemotherapy.

Fig. 2.

Overall survival according to initial hemoglobin (Hb) level.

Fig. 3.

Overall survival according to whether or not follow-up CEA level was elevated.

Fig. 4.

Overall survival according to disease response.

Table 1.

Characteristics of Patients (n=75)

Characteristic		Data
Age (yr)		64 (42–85)
Sex	Male	40 (53.3)
	Female	35 (46.7)
Regimen	FOLFOX-4	51 (68.0)
	FOLFIRI	24 (32.0)
Chemotherapy cycle		6
		2–15
Metastasis site	Liver	49 (55.7)
	Lung	11 (12.5)
	Lymph node	21 (23.8)
	Others	7 (8.0)
BMI (kg/m²)	＜25	54 (72.0)
	25–30	18 (24.0)
	＞30	3 (4.0)
ECOG	0–1	56 (74.7)
	2	19 (25.3)
Location	Right	19 (25.3)
	Left	56 (74.7)
Borrmann type	1–3	71 (94.7)
	4–5	4 (5.3)
Pathology	Well – moderate	54 (72.0)
	Poorly – SRC	21 (28.0)
Initial CTx+surgery	Yes	12 (16.0)
	No	63 (84.0)
Metastasis (n)	1	63 (84.0)
	≥2	12 (16.0)
Initial BW loss	Yes	28 (37.3)
	No	47 (62.7)
Initial Hb (g/dL)	≥10	62 (82.7)
	＜10	13 (17.3)
Initial albumin (g/dL)	≥3.5	50 (66.7)
	＜3.5	25 (33.3)
Initial CEA (ng/mL)	≥10	55 (73.3)
	＜10	20 (26.7)
Follow-up BW loss	Yes	26 (34.7)
	No	49 (65.3)
Follow-up CEA elevation	Yes	26 (41.3)
	No	49 (58.7)
Response of CTx	CR, PR, SD	62 (82.7)
	PD	13 (17.3)

Values are presented as median (range) or number of patients (%). FOLFOX-4, Oxaliplatin, Leucovorin, and 5-Fluorouracil regimen; FOLFIRI, Irinotecan, Leucovorin, and 5-Fluorouracil regimen; ECOG, Eastern Cooperative Oncology Group; SRC, signet ring cell; CTx, chemotherapy; BW, body weight; Hb, hemoglobin; CR, complete remission; PR, partial remission; SD, stable disease; PD, progression disease.

Table 2.

Univariate Analysis of Overall Survival (OS)

		Patient (n)	Median OS (mo)	p-value
Age (yr)	≤ 64	32	16.27	0.290
	＞64	43	14.40
Sex	Male	40	10.73	0.156
	Female	35	20.33
BMI (kg/m²)	＜25	54	14.00	0.563
	25–30	18	15.87
	＞30	3	16.27
ECOG	0–1	56	15.87	0.078
	2	19	10.73
Location	Right	19	9.03	0.263
	Left	56	15.87
Borrman type	1–3	71	14.40	0.957
	4–5	4	20.33
Pathology	Well – moderate	54	15.17	0.848
	Poor – SRC	21	10.73
Initial CTx+surgery	Yes	12	54.49	0.002
	No	63	16.15
Metastasis (n)	1	63	14.00	0.919
	≥2	12	16.27
Initial BW loss	Yes	28	14.00	0.726
	No	47	15.87
Initial Hb (g/dL)	≥10	62	16.27	＜0.001
	＜10	13	4.50
Initial albumin (g/dL)	≥3.5	50	15.87	0.444
	＜3.5	25	14.00
Initial CEA (ng/mL)	≥10	55	14.27	0.636
	＜10	20	19.10
Follow-up BW loss	Yes	26	14.27	0.843
	No	49	15.87
Follow-up CEA elevation	Yes	26	8.87	0.030
	No	49	16.87
Disease response	CR, PR, SD	62	15.87	0.020
	PD	13	5.53

ECOG, Eastern Cooperative Oncology Group; SRC, signet ring cell; CTx, chemotherapy; BW, body weight; Hb, hemoglobin; CR, complete remission; PR, partial remission; SD, stable disease; PD, progression disease.

Table 3.

Multivariate Analysis of Overall Survival

	OR	95% CI	p-value
Initial CTx+surgery	9.769	2.464–38.727	0.001
Initial Hb (g/dL)	7.600	2.638–21.898	＜0.001
Follow-up CEA elevation (ng/mL)	0.660	0.306–1.428	0.292
Disease response	3.396	1.282–9.001	0.014

CTx, chemotherapy; Hb, hemoglobin.

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