A Prognostic Model To Predict Survival In Stage III Colon Cancer Patients Based on Histological Grade, Preoperative Carcinoembryonic Antigen Level and the Neutrophil Lymphocyte Ratio

Abstract

<b>Background:</b> Stage III colon cancer patients demonstrate diverse clinical outcomes. The aim of this studywas to develop a prognostic model in order to better predict their survival. Materials and <br/><b>Methods</b>: From 2004to 2010, 548 patients were retrospectively analyzed, among whom 328 were defined as the study group and theremaining 220 served as a validation group. Clinico-pathologic features, including age, gender, histological grade,T stage, number of positive lymph nodes, number of harvest lymph nodes, pretreatment carcinoembryonic antigen(CEA) levels and pretreatment neutrophil lymphocyte ratio (NLR), were collected. Kaplan-Meier survival curveswere used to detect prognostic factors and multivariate analysis was applied to identify independent exampleson which to develop a prognostic model. Finally, the model was further validated with the validation group.<br/><b>Results</b>: Histological grade (p=0.002), T stage (p=0.011), number of positive lymph nodes (p=0.003), number ofharvested lymph nodes (p=0.020), CEA (p=0.005), and NLR (p<0.001) were found as prognostic factors whilehistological grade [RR(relative risk):0.632, 95%CI (Confidence interval) 0.405~0.985, p=0.043], CEA (RR:0.644,95%CI:0.431~0.964, p=0.033) and NLR (RR:0.384, 95%CI:0.255~0.580, p<0.001) levels were independent. Theprognostic model based on these three factors was able to classify patients into high risk, intermediate and lowrisk groups (p<0.001), both in study and validation groups. <br/><b>Conclusions</b>: Histological grade, pretreatment CEAand NLR levels are independent prognostic factors in stage III colon cancer patients. A prognostic model basedon these factors merits attention in future clinical practice.