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Matthew R. Dixon, MD; Jason S. Haukoos, MD, MS; Sejal M. Udani; Jesse J. Naghi; Tracey D. Arnell, MD; Ravin R. Kumar, MD; Michael J. Stamos, MD

Arch Surg. 2003;138:962-966.

Hypothesis  Patients with stage IV colon or rectal cancer at initial diagnosis have characteristics that will predict subsequent survival time.

Design  Retrospective cohort study.

Setting  Urban county teaching hospital providing tertiary care.

Patients  Patients who came to the study institution with stage IV colon or rectal cancer between 1991-1999.

Main Outcome Measure  Survival duration (days) after diagnosis.

Results  One hundred five patients were identified, with a median survival of 225 days (interquartile range, 72-688 days). Univariate analysis identified carcinoembryonic antigen (CEA) and albumin (ALB) as possible predictors for survival. Classification and regression tree analysis, a form of binary recursive partitioning, was used to identify optimal cut points for CEA (275 ng/mL) and ALB (2.7 g/dL) levels. Based on the cut points, patients were stratified into the following groups: (1) low CEA, high ALB; (2) low CEA, low ALB; (3) high CEA, high ALB; and (4) high CEA, low ALB. The median survival times for the first group and the fourth group were 287 days (interquartile range, 150-851 days) and 39 days (interquartile range, 14-168 days), respectively. A Kaplan-Meier analysis was performed, and a statistically significant difference was identified across all strata (P = .004). Additionally, groups 1 and 4 demonstrated the largest overall survival difference (P<.001).

Conclusions  Patients with stage IV colon and rectal cancer with a CEA level greater than or equal to 275 ng/mL and an ALB level less than 2.7g/dL had a significantly shorter survival time. Conversely, patients with an ALB level greater than or equal to 2.7 g/dL and a CEA level less than 275 ng/mL had a longer survival time.

From the Division of Colon and Rectal Surgery, Harbor–University of California–Los Angeles (UCLA) Medical Center, Torrance (Drs Dixon and Kuma Mr Naghi, and Ms Udani); Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance (Dr Haukoos); Division of Colon and Rectal Surgery, University of California–Irvine Medical Center, Orange (Dr Stamos); and the Department of Surgery, Division of Colorectal Surgery, Columbia–Presbyterian Medical Center, New York, NY (Dr Arnell).

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