PURPOSE: We investigated the effects of proteinuria and renal insufficiency on all-cause mortality in patients with colorectal cancer, with special emphasis on cancer staging and cancer-related deaths. MATERIALS AND METHODS: We retrospectively studied a cohort of patients with colorectal cancer. In protocol 1, patients were classified into four groups based on the operability of cancer and proteinuria: group 1, early-stage cancer patients (colorectal cancer stage < or =3) without proteinuria; group 2, early-stage cancer patients with proteinuria; group 3, advanced-stage cancer patients without proteinuria (colorectal cancer stage=4); and group 4, advanced-stage cancer patients with proteinuria. In protocol 2, patients were classified into four similar groups based on cancer staging and renal insufficiency (eGFR <60 mL/min/1.73 m2). Between January 1, 1998 and December 31, 2009, 3379 patients were enrolled in this cohort and followed until May 1, 2012 or until death. RESULTS: The number of patients with proteinuria was 495 (14.6%). The prevalence of proteinuria was higher in advanced-stage cancer (n=151, 22.3%) than in early-stage cancer patients (n=344, 12.7%). After adjusting for age, gender and other clinical variables, the proteinuric, early-stage cancer group was shown to be associated with an adjusted hazard ratio of 1.67 and a 95% confidence interval of 1.38-2.01, compared with non-proteinuric early-stage cancer patients. However, renal insufficiency was not associated with colorectal cancer mortality. CONCLUSION: Proteinuria is an important risk factor for cancer mortality, especially in relatively early colorectal cancer.
Aged ; Colorectal Neoplasms/complications/*mortality/pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prevalence ; Proteinuria/*complications/epidemiology ; Renal Insufficiency/complications ; Retrospective Studies ; Risk Factors

OBJECTIVETo explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for evaluating the prognosis of the patients with CRC.

METHODS370 cases with CRC were selected in the study and clinical/pathological factors were collected and patients were followed. Kaplan-Meier method was used to calculate survival rate. Log-rank test and proportional-hazards regression model (Cox model) were used for univariate and multivariate analysis. Log cumulative hazards function plot was used to test Cox model proportional-hazards assumption (PH assumption). Prognostic index (P1) was calculated based on the results of multivariate analysis.

RESULTS(1) One-year, three-year and five-year survival rates were 90.5%, 78.3% and 76.5% respectively. (2) Lymphatic metastasis, Duckes classification and therapeutic measure were independent prognostic factors of CRC and all passed PH assumption. (3) Patients with different PI were classified into 3 groups and there were significant differences noticed in survival rates (P < 0.001). (4) Individual survival rate was evaluated based on the prognostic Cox model and PI.

CONCLUSIONLymphatic metastasis, Duckes classification and therapeutic measure were independent prognostic factors of CRC. To test PH assumption of the factors, selection of Cox model was essential. Cox model and PI seemed to be available in predicting the long term survivrate of patients with CRC.

Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms ; complications ; mortality ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Survival Analysis