Postoperative hyperphosphatemia significantly associates with adverse survival in colorectal cancer patients.

Zhong Ye, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University
Juan P. Palazzo, Department of Pathology, Thomas Jefferson University
Liz Lin, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University
Yinzhi Lai, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University
Fran Guiles, Oncology Data Service, Thomas Jefferson University
Ronald E. Myers, PhD, DSW, Director, Division of Population Science, and Professor, Department of Medical Oncology, Jefferson Medical College
Jin Han, Department of Pharmacy, Rush University Medical Center
Jinliang Xing, Experimental Teaching Center, Fourth Military Medical University
Hushan Yang, Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University

Document Type Article

This article has been peer reviewed. It was published in: Journal of Gastroenterology and Hepatology (Australia).

Volume 28, Issue 9, September 2013, Pages 1469-1475.

The published version is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775915/

Copyright © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Abstract

BACKGROUND AND AIM: Hyperphosphatemia has been implicated in the development and treatment of various cancers. However, whether it can be used as a direct prognostic marker of colorectal cancer (CRC) has remained unexplored. Given new insights into the importance of hyperphosphatemia in CRC, we sought to evaluate the association of hyperphosphatemia with the clinical outcomes of this disease.

METHODS: In a retrospective analysis of a well-characterized clinic-based cohort with 1241 CRC patients, we assessed the association of postoperative hyperphosphatemia with patient overall survival.

RESULTS: Postoperative hyperphosphatemia measured within the first month after surgery was significantly associated with CRC survival. Compared to patients with a normal phosphate level, those with hyperphosphatemia exhibited a significant unfavorable overall survival with a hazard ratio (HR) of 1.84 (95% confidence interval [CI] 1.49-2.29, P = 2.6 × 10(-8) (log-rank P = 1.2 × 10(-7) ). Stratified analyses indicated the association was more pronounced in patients with colon (HR = 2.00, 95% CI 1.57-2.56, P = 3.17 × 10(-8) ) but not rectal cancer (HR = 0.96, 95% CI 0.58-1.59, P = 0.889) (P interaction = 0.023), as well as in those not receiving chemotherapy (HR = 2.15, 95% CI 1.59-2.90, P = 6.2 × 10(-7) ) but not in those receiving chemotherapy (HR = 1.30, 95% CI 0.92-1.82, P = 0.136) (P interaction = 0.012). Flexible parametric survival model demonstrated that the increased risk for death conferred by postoperative hyperphosphatemia persisted over 150 months after surgery.

CONCLUSION: Our data indicated that postoperative hyperphosphatemia might be used as a prognostic marker of CRC patients after surgery. Since phosphate level is routinely tested in clinics, it may be incorporated into clinical models to predict CRC survival.