Background
Methods
Data collection and definitions
Statistical analyses
Results
Patient characteristics and bias in urgent versus elective operation
Patient characteristics in univariate analysis | Bias in multivariable logistic regression | Patient characteristics after propensity score matching | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total N = 747 | Urgent N = 84 | Elective N = 663 |
p
| OR (95 % CI) |
p
c
| Urgent N = 83 | Elective N = 621 |
p
| ||
Age | years | 71.4 ± 12.1 | 72.0 ± 11.2 | 71.3 ± 12.2 | 0.884a | 1.01 (0.99–1.03) | 0.490 | 72.1 ± 11.3 | 72.5 ± 11.7 | 0.760a |
Sex | m | 421 (56.4 %) | 43 (51.2 %) | 378(57.0 %) | 0.311b | Reference | 0.517 | 42 (50.6 %) | 333.5 (53.7 %) | 0.594b |
w | 326 (43.6 %) | 41 (48.8 %) | 285 (43.0 %) | 1.19 (0.71–1.99) | 41 (49.4 %) | 287.5 (46.3 %) | ||||
Tumor localisation | Cecum | 132 (17.7 %) | 12 (14.3 %) | 120 (18.1 %) | 0.019b | Reference | 0.092 | 12 (14.5 %) | 95.4 (15.4 %) | 0.927b |
Ascending colon | 130 (17.4 %) | 12 (14.3 %) | 118 (17.8 %) | 1.25 (0.50–3.19) | 12 (14.5 %) | 82.4 (13.3 %) | ||||
Transverse colon | 40 (5.4 %) | 7 (8.3 %) | 33 (5.0 %) | 2.50 (0.80–7.43) | 7 (8.4 %) | 55.7 (9.0 %) | ||||
Descending colon | 81 (10.8 %) | 12 (14.3 %) | 69 (10.4 %) | 2.29 (0.88–6.01) | 12 (14.5 %) | 80.9 (13.0 %) | ||||
Sigmoid colon | 201 (26.9 %) | 32 (38.1 %) | 169 (25.5 %) | 1.95 (0.90–4.44) | 31 (37.3 %) | 258.1 (41.6 %) | ||||
Rectum | 163 (21.8 %) | 9 (10.7 %) | 154 (23.2 %) | 0.78 (0.28–2.12) | 9 (10.8 %) | 48.7 (7.8 %) | ||||
Perforation | No | 674 (90.2 %) | 56 (66.7 %) | 618 (93.2 %) | <0.001b | Reference | <0.001 | 56 (67.5 %) | 465.5 (75.0 %) | 0.144b |
Yes | 73 (9.8 %) | 28 (33.3 %) | 45 (6.8 %) | 7.17 (3.93–13.09) | 27 (32.5 %) | 155.5 (25.0 %) | ||||
Protective colostomy | No | 657 (88.0 %) | 71 (84.5 %) | 586 (88.4 %) | 0.306b | Reference | 0.129 | 70 (84.3 %) | 512.7 (82.6 %) | 0.687b |
Yes | 90 (12.0 %) | 13 (15.5 %) | 77 (11.6 %) | 1.82 (0.83–3.80) | 13 (15.7 %) | 108.3 (17.4 %) | ||||
Resection status | R0 | 718 (96.1 %) | 76 (90.5 %) | 642 (96.8 %) | 0.014c | Reference | 0.114 | 76 (91.6 %) | 571.8 (92.1 %) | 0.870b |
R1/2 | 29 (3.9 %) | 8 (9.5 %) | 21 (3.2 %) | 2.32 (0.81–6.09) | 7 (8.4 %) | 49.2 (7.9 %) | ||||
UICC Stage | I | 166 (22.2 %) | 13 (15.5 %) | 153 (23.1 %) | 0.332b | Reference | 0.599 | 13 (15.7 %) | 69.9 (11.3 %) | 0.698b |
II | 212 (28.4 %) | 23 (27.4 %) | 189 (28.5 %) | 1.41 (0.63–3.29) | 23 (27.7 %) | 172.4 (27.8 %) | ||||
III | 220 (29.5 %) | 27 (32.1 %) | 193 (29.1 %) | 1.30 (0.55–3.15) | 26 (31.3 %) | 209.8 (33.8 %) | ||||
IV | 149 (19.9 %) | 21 (25.0 %) | 128 (19.3 %) | 1.83 (0.72–4.71) | 21 (25.3 %) | 168.9 (27.2 %) | ||||
Tumor diameter | mm | 45.8 ± 21.6 | 45.7 ± 20.6 | 45.8 ± 21.7 | 0.831a | 0.99 (0.98–1.00) | 0.107 | 45.6 ± 20.7 | 43.7 ± 19.3 | 0.421a |
Lymph node yield | <12 | 166 (22.2 %) | 10 (11.9 %) | 156 (23.5 %) | 0.016b | Reference | 0.040 | 10 (12.0 %) | 46.1 (7.4 %) | 0.143b |
12+ | 581 (77.8 %) | 74 (88.1 %) | 507 (76.5 %) | 2.08 (1.03–4.58) | 73 (88.0 %) | 574.9 (92.6 %) | ||||
Tumor grading | G1 | 23 (3.1 %) | 3 (3.6 %) | 20 (3.0 %) | 0.180b | Reference | 0.196 | 3 (3.6 %) | 29.2 (4.7 %) | 0.823b |
G2 | 540 (72.3 %) | 53 (63.1 %) | 487 (73.5 %) | 0.45 (0.14–2.03) | 52 (62.7 %) | 355.9 (57.3 %) | ||||
G3 | 148 (19.8 %) | 21 (25.0 %) | 127 (19.2 %) | 0.62 (0.17–2.99) | 21 (25.3 %) | 175.1 (28.2 %) | ||||
GX | 36 (4.8 %) | 7 (8.3 %) | 29 (4.4 %) | 1.21 (0.26–6.73) | 7 (8.4 %) | 60.7 (9.8 %) | ||||
Adjuvant Chemotherapy | No | 505 (67.6 %) | 51 (60.7 %) | 454 (68.5 %) | 0.152b | Reference | 0.785 | 51 (61.4 %) | 382.8 (61.6 %) | 0.973b |
Yes | 242 (32.4 %) | 33 (39.3 %) | 209 (31.5 %) | 1.09 (0.59–2.01) | 32 (38.6 %) | 238.2 (38.4 %) |
Urgent operation as a prognostic factor for overall survival
Prognostic factors | Overall survival | Disease free survival | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Unadjusteda | Full modelb | Backwards variable selectionc | Unadjusteda | Full modelb | Backwards variable selectionc | ||||||||
HR (95 % CI) | p * | HR (95 % CI) | p* | HR (95 % CI) | p* | HR (95 % CI) | p* | HR (95 % CI) | p * | HR (95 % CI) | p* | ||
Cancer resection | Elective | Reference | 0.045 | Reference | 0.629 | – | – | Reference | 0.043 | Reference | 0.877 | – | – |
Urgent | 1.35 (1.02–1.78) | 1.08 (0.79–1.48) | – | – | 1.33 (1.02–1.74) | 1.02 (0.76–1.38) | – | – | |||||
Age | years | 1.04 (1.03–1.05) | <0.001 | 1.05 (1.04–1.06) | <0.001 | 1.05 (1.04–1.06) | <0.001 | 1.03 (1.03–1.04) | <0.001 | 1.04 (1.03–1.05) | <0.001 | 1.04 (1.03–1.05) | <0.001 |
Sex | m | Reference | 0.973 | Reference | 0.850 | – | – | Reference | 0.478 | Reference | 0.381 | – | – |
w | 1.00 (0.84–1.20) | 0.98 (0.81–1.19) | – | – | 0.94 (0.79–1.12) | 0.92 (0.76–1.11) | – | – | |||||
Tumor localisation | Cecum | Reference | 0.004 | Reference | 0.002 | Reference | 0.003 | Reference | 0.018 | Reference | 0.026 | Reference | 0.031 |
Asc. colon | 0.72 (0.53–0.96) | 0.60 (0.44–0.82) | 0.62 (0.46–0.83) | 0.76 (0.57–1.02) | 0.67 (0.49–0.91) | 0.68 (0.50–0.91) | |||||||
Transv. colon | 0.81 (0.53–1.23) | 0.62 (0.40–0.97) | 0.63 (0.41–0.97) | 0.78 (0.51–1.18) | 0.62 (0.40–0.95) | 0.63 (0.41–0.96) | |||||||
Desc. olon | 0.87 (0.62–1.22) | 0.90 (0.63–1.28) | 0.90 (0.64–1.27) | 0.94 (0.68–1.31) | 0.99 (0.70–1.39) | 1.03 (0.74–1.45) | |||||||
Sigm. colon | 0.73 (0.56–0.95) | 0.66 (0.50–0.88) | 0.68 (0.51–0.89) | 0.80 (0.62–1.04) | 0.79 (0.60–1.05) | 0.83 (0.63–1.08) | |||||||
Rectum | 0.56 (0.42–0.74) | 0.57 (0.42–0.79) | 0.58 (0.43–0.78) | 0.62 (0.47–0.81) | 0.70 (0.51–0.95) | 0.74 (0.56–0.99) | |||||||
Perforation | No | Reference | 0.525 | Reference | 0.492 | – | – | Reference | 0.684 | Reference | 0.704 | – | – |
Yes | 1.10 (0.82–1.49) | 1.13 (0.80–1.58) | – | – | 1.06 (0.79–1.42) | 1.07 (0.77–1.48) | – | – | |||||
Protec. colostomy | No | Reference | 0.929 | Reference | 0.530 | – | – | Reference | 0.987 | Reference | 0.783 | – | – |
Yes | 1.01 (0.77–1.33) | 1.10 (0.81–1.50) | – | – | 1.00 (0.77–1.31) | 1.04 (0.77–1.41) | – | – | |||||
Resection status | R0 | Reference | <0.001 | Reference | 0.001 | Reference | <0.001 | Reference | <0.001 | Reference | 0.004 | Reference | 0.003 |
R1/2 | 3.21 (2.16–4.75) | 2.22 (1.45–3.38) | 2.30 (1.52–3.49) | 3.07 (2.08–4.55) | 1.97 (1.29–3.02) | 1.97 (1.30–3.00) | |||||||
UICC Stage | I | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
II | 1.28 (0.97–1.69) | 1.21 (0.89–1.64) | 1.25 (0.93–1.67) | 1.41 (1.08–1.85) | 1.39 (1.03–1.87) | 1.37 (1.03–1.82) | |||||||
III | 1.67 (1.27–2.19) | 1.67 (1.22–2.29) | 1.74 (1.29–2.36) | 1.80 (1.38–2.34) | 1.79 (1.31–2.43) | 1.75 (1.30–2.36) | |||||||
IV | 4.02 (3.02–5.35) | 4.89 (3.45–6.94) | 5.10 (3.64–7.14) | 4.83 (3.65–6.40) | 5.64 (3.99–7.97) | 5.58 (4.00–7.79) | |||||||
Tumor diameter | mm | 1.00 (1.00–1.01) | 0.071 | 1.00 (1.00–1.01) | 0.730 | – | – | 1.00 (1.00–1.01) | 0.043 | 1.00 (1.00–1.01) | 0.829 | – | – |
Lymph node yield | <12 | Reference | 0.662 | Reference | 0.006 | Reference | 0.007 | Reference | 0.662 | Reference | 0.173 | – | – |
12+ | 0.95 (0.77–1.18) | 0.72 (0.57–0.91) | 0.73 (0.58–0.91) | 1.05 (0.85–1.29) | 0.85 (0.68–1.07) | – | – | ||||||
Tumor grading | G1 | Reference | 0.012 | Reference | 0.367 | – | – | Reference | 0.001 | Reference | 0.009 | Reference | 0.007 |
G2 | 1.09 (0.65–1.82) | 1.23 (0.72–2.09) | – | – | 1.07 (0.65–1.77) | 1.21 (0.72–2.03) | 1.20 (0.72–2.00) | ||||||
G3 | 1.58 (0.92–2.71) | 1.41 (0.80–2.47) | – | – | 1.66 (0.98–2.81) | 1.45 (0.84–2.50) | 1.42 (0.83–2.45) | ||||||
GX | 1.33 (0.69–2.57) | 1.59 (0.81–3.14) | – | – | 1.57 (0.84–2.95) | 2.44 (1.27–4.68) | 2.49 (1.31–4.73) | ||||||
Adjuvant chemo. | No | Reference | 0.679 | Reference | 0.042 | Reference | 0.027 | Reference | 0.501 | Reference | 0.142 | Reference | 0.142 |
Yes | 0.96 (0.79–1.17) | 0.77 (0.60–0.99) | 0.76 (0.60–0.97) | 1.07 (0.88–1.29) | 0.84 (0.66–1.06) | 0.84 (0.66–1.06) |