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Mortality and Risk in Non-curable, Surgically-treated Stage IV Colorectal Cancer
*Erin Teeple, *Arin Madenci, *Katerina Kimonis, *Jiping Wang, *Ronald Bleday, *Joel Goldberg
Brigham and Women's Hospital, Boston, MA

Objective: To develop a risk score to predict mortality for patients with non-curable, stage IV colorectal cancer (CRC) and an intact primary to help determine which sub-groups of patients may benefit from resection of their primary.
Design: Retrospective review of a prospective database (2000-2012). Multivariable analysis was performed using Cox proportional hazards modeling with a risk score generated from hazard ratios. Survival times for risk score strata were estimated using the Kaplan-Meier method. Median follow-up was 541 days.
Setting: Academic Medical Cancer Center.
Patients: Patients who presented with non-curable stage IV CRC (n=501) who had elective primary resection. We excluded patients who were initially curable and then developed distant disease.
Interventions: None.
Main Outcome Measures: Overall mortality.
Results: Mortality was significantly increased with high-grade tumors (hazard ratio [HR]=1.4, 95% confidence interval [CI]=1.2-1.8, age>60 (HR=1.3, 95% CI=1.1-1.6, P=0.01), >1 site of metastatic disease (HR=1.6, 95% CI=1.3-2.0, P<0.01). One point was assigned for each risk factor with a range of 0-3. The one, two and three year percent survival for each risk score were as follows: 0 points, 88.8%/66.9%/37.6%; 1 point, 76.2%/46.4%/23.6%; 2 points, 65.3%/34.1%/19.7%; and 3 points, 45.5%/20.5%/10.2%. The median survival in all non-curable patients is 23.4 months. For risk scores of 0, 1, 2, and 3 median survival was 30.7 months, 23.3 months, 18.2 months, and 8.7 months respectively.
Conclusions: Patients with 0 points on our risk scale (single site metastatic disease, non high grade tumor and < 60 years old) had a median survival of 30.7 months. Our risk model may help guide preoperative discussion in patients with non-curable stage IV CRC.


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