The strongest prognostic factors in colorectal carcinoma

Abstract

Of 227 patients with stage B or C colorectal carcinoma operated for cure, 132 had a febrile postoperative course. Of the latter, 5 patients (3.7%) died of sepsis. The 5-yr actuarial recurrence rate for 227 patients was 53%. When the patients were divided into groups according to stage of disease and postoperative fever, the following was found: Eighty-one low stage patients (B1 + B2) had a 34% 5-yr actuarial recurrence rate, and 146 high-stage patients (B3 + C1 + C2.sbd.a 71% rate (P < 0.0005). Fever occurred postoperatively in 46% of low-stage patients and in 65% of high-stage patients (P = 0.004). In low-stage patients, the 5-yr actuarial recurrence rate was 3% in the group with an afebrile postoperative course, and 66% in the group with fever (P << 0.0005). Similarly, in high-stage patients, the recurrence rate was 24 and 93% respectively, in the group with afebrile and febrile postoperative courses (P << 0.0005). Preoperative plasma CEA [carcinoembryonic antigen] levels seemed to have no bearing upon prognosis, unless > 20 ng/ml. A total of 82% of patients who had serial postoperative plasma CEA measurements and recurrence of cancer had increasing CEA levels. Thus, postoperative fever lasting 2 or more days was the most unfavorable prognostic factor, highly significant statistically, whereas stage of disease ranked only 2nd in isolating better prognoses among operated patients from those at higher risks of recurrence.