OPEN ACCESS Human & Veterinary Medicine International Journal of the Bioflux Society Research Article Volume 7 | Issue 2 Page 47 HVM Bioflux http://www.hvm.bioflux.com.ro/ Assessment of clinical and pathological prognostic factors for colorectal cancer recurrence after surgery 1 Bogdan Micu, 1,2 Carmen Micu, 3 Liliana Dina, 4 Octavian Andercou, 1 Nicolae Constantea 1 Vth Surgical Departament, “Iuliu Hatieganu” University of Medicine and Pharmacy, Muncipal Clinical Hospital, Cluj-Napoca, Romania; 2 Department of Anatomy and Embryology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; 3 Department of Gastroenterology, “Octavian Fodor” Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; 4 IInd Surgical Departament, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency County Clinic Hospital, Cluj-Napoca, Romania. Introduction Colorectal cancer is still a leading cause of death in developed countries and there has been no significant improvement in the 5-year survival rate (van de Velde et al 2013). Prognostic fac- tors should always be considered before therapy planning for colorectal cancer. Although the AJCC/UICC TNM staging system (Stephen et al 2010) is currently the most powerful prognostic parameter in patients with colorectal cancer, new histopathological prog- nostic factors are needed in order to improve clinical decisions regarding postoperative follow-up and the management of ad- juvant therapy. Despite radical treatment, many patients experience local and/ or distant recurrences. These high-risk patients require a more aggressive treatment or a more careful postoperative follow- up in order to improve prognosis. Therefore, the development of new therapeutic techniques should also be accompanied by a preoperative staging system classifying patients according to the risk of cancer recurrence and survival rates. Although therapeutic procedures are well established and they are equally applied to all patients, the results in terms of sur- vival and cancer recurrence incidence vary, probably due to the impact of certain prognostic factors that depend on both indi- vidual and tumour characteristics. Based on existing data in the literature, the aim of the present study was to assess and analyse the prognostic factors for sur- vival in patients who had been previously subjected to curative surgery for colorectal cancer. Moreover, the aim was to identify Abstract. Aim: to assess and analyse the prognostic factors for survival in patients who had been previously subjected to curative surgery for colorectal cancer. Moreover, the aim was to identify and consider new prognostic factors in colorectal cancer, to assess the prognostic role of local and systemic inflammatory response, as well as the prognostic role of lymph node ratio (LNR) in stage III colorectal cancer subjected to radical surgery. Material and methods: patients diagnosed with stage I-III colorectal cancer, admitted and undergoing radical surgery within the 5th Surgical Clinic of Cluj-Napoca Municipal Hospital between January 1999 and December 2008 were included in the study. A database was created, including demographic data, clinical and anamnestic data, laboratory exams, paraclinical examinations, intraoperative findings, mor- phopathological examination. The Petersen index was calculated using four morphopathological variables, each being assigned a score. Local inflammatory response was calculated using Klintrup criteria. For patients with stage III cancer, the lymph node ratio (LNR) was calculated by dividing the number of tumour invaded lymph nodes to the total number of resected lymph nodes. Results: there were 112 (37.2%) patients in the study experiencing cancer recurrence during the 5-year follow-up, and 189 (62.8%) patients who did not develop recurrence. Patients with grade 4 cancer had a higher likelihood of cancer recurrence than those with grade 1 cancer (HR-13.4; 95%CI=3.15-61.62; p=0.001). Patients with stage IIIB cancer were more likely to develop recurrences than those with stage I cancer (HR-7.22; 95%CI=0.92-56.26; p=0.05). Patients with stage IIIC cancer were more likely to develop recurrences than those with stage I cancer (HR - 9.75; 95% CI 1.23-77.35; p=0.03). Patients with Kintrup score >1 had a better prognosis than those with Klintrup ≤1 (HR-0.10; 95%CI=0.04-0.25; p<0.001). Patients with Petersen score >1 had a worse prognosis than those without venous invasion (HR-1.92; 95%CI=1.17-3.61; p=0.01). Patients with necrosis score 2 had a poor- er prognosis than those with score 0 (HR-2.84; 95%CI=1.31-6.16; p=0.008). Patients with desmoplasic score 3 had lower recurrence rates than those with score 1 (HR-0.43, 95%CI=0.22-0.95; p=0.01). The other variables did not have an independent influence on the prognosis of five- year survival. Conclusion: cancer recurrences were more frequent in patients with tumour grade 4, stage IIIB or IIIC. The independent prog- nostic role of Klintrup and Petersen scores in cancer recurrences was also demonstrated. Desmoplasia score was an independent and positive prognostic factor for 5-year recurrence in patients with colorectal cancer who had curative surgery. Key Words: colorectal cancer, recurrence, prognostic factors. Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Corresponding Authors: L. Dina, email: dina_a_lili@yahoo.com