Preoperative Prognostic Factors of Colorectal Cancer in Patients from Central China: A Retrospective Observational Study

Purpose: This study aimed to investigate the clinicopathological characteristics and identify prognostic factors influencing overall survival (OS) in colorectal cancer (CRC) patients from central China. Patients and Methods: We conducted a retrospective analysis of clinicopathologic data obtainable at the preoperative decision point from 1452 patients with pathologically confirmed CRC who underwent surgical resection between January 2015 and December 2017 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in central China. Associations between clinicopathological variables and OS were evaluated using independent sample tests, Kaplan-Meier survival analysis, and Log rank tests. A Cox proportional hazards model was employed to identify independent predictors of OS. Results: Of 1452 patients, 58.9% were male and 41.1% female (ratio 1.43:1). Multivariate logistic regression identified age, tumor differentiation, preoperative CEA, and metastasis as independent mortality predictors (all P ≤ 0.01; Table 1). A univariate analysis of this predominantly rectal-cancer cohort (51.9%) revealed that numerous clinicopathological variables, including age, tumor size, grade, tumor deposits, perineural and vascular invasion, nodal status, surgical margins, clinical stage, primary site, preoperative CEA, treatment modality, distant metastasis, and recurrence, were each significantly associated with overall survival (Table 2). In the overall cohort, age ≥75 years (OR = 3.812), poor differentiation (OR = 2.590), elevated CEA (OR = 4.594), and liver metastasis (OR = 4.370) were independently associated with higher mortality (all P ≤ 0.045; Table 3). Subgroup analyses (Table 4) showed that in colon cancer, age ≥75 years (OR = 4.961, P = 0.001) and metastasis (OR = 37.029, P < 0.001) increased mortality risk. In rectal cancer, lymph node involvement (1-3 nodes: OR = 2.968, P = 0.004; 4-6: OR = 4.771, P = 0.001; ≥7: OR = 11.131, P < 0.001) and metastasis (OR = 1.292, P < 0.001) were independent risk factors, while elevated CEA was not significant (P = 0.065). Conclusion: In this large cohort, mortality risk in CRC is independently associated with age, differentiation, CEA, and metastasis-with distinct risk patterns between colon and rectal cancers-highlighting the importance of primary tumor location in prognostic assessment.