Patient characteristics associated with poor performance status, ECOG 2-3, and effect on survival in 1086 Finnish metastatic colorectal cancers (mCRC) nationwide (prospective RAXO study)

Abstract

significance of impact on quantitative variables, while for qualitative variables chi-squared tests were used to compare patient from different BMI groups. Results: The study included 237 patients with mCRC. The median age of the patients was 65 years (range 34-82). The study group included 54% of males. The median OS and PFS in the study group was 14.6 and 8.8 months, respectively. The comparison of obese vs overweight vs normal BMI range patients revealed a significant difference in mOS (17.5 vs 14.3 vs 13.1 months, p ¼ 0.01) and mPFS (9.4 vs 9.1 vs 7.3 months, p ¼ 0.03). The regression analysis (Pearson's linear correlation) also confirmed that there is a statistically significant relationship between the length of OS and PFS and the BMI value. Higher BMI was associated with a better prognosis. The location of the primary lesion on the left side of the colon, less than two metastatic sites and CEA within the normal range before start of the treatment was linked with statistically longer OS. Conclusions: Obese and overweight patients presented longer OS and PFS compared with normal weight patients with mCRC cancer treated with bevacizumab plus FOLFOX chemotherapy regimen. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest. 652P Patient characteristics associated with poor performance status, ECOG 2-3, and effect on survival in 1086 Finnish metastatic colorectal cancers (mCRC) nationwide (prospective RAXO study) Background: ECOG 2-3 patients are poorly represented in prospective studies (only 7% in Sorbye et al, Ann Oncol 2007) and efficacy outcomes are poor. Natural course of mCRC and metastasectomies were the primary endpoints of this prospective Finnish nationwide study initiated in 2011. Methods: 1086 mCRCs referred for oncological treatments at all 21 oncology units (40% of eligible mCRCs in Finland) were included. Prognostic and predictive factors, resectability, treatment history and outcome measures were assessed. Results: Baseline ECOG was 0 in 295 (27%), 1 in 600 (55%) and 2-3 in 191 (18%). Strongest baseline patient characteristics in multivariable logistic regression models (n ¼ 851) for ECOG 2-3 status were: age >70 (odds ratio 3.00), BMI <20 (2.26), >3 comorbidities (2.61), >3 regular drugs (1.67), >2 symptoms at mCRC diagnosis (3.05), abnormal physical exam (2.22), bone metastases (3.37), BRAF mutation (2.44), neutrophil-to-lymphocyte ratio >3.00 (2.75), alkaline phosphatase ALP >300 (3.08), leukocytes >10 (1.88), haemoglobin <11 (1.70) and in univariable analysis also, daily drinking (2.55), smoking (1.98), primary in-situ (2.38), >3 metastatic sites (1.92), synchronous mets (1.77); suprarenal (2.87), liver (1.53) and lymph node metastases (1.44); neutrophils >6.7 (4.54), platelets >400 (1.73), CRP >10 (3.37), albumin <30 (4.70), CEA >5 (2.51) and Ca19-9 >25 (1.61). Sex, second cancers, sidedness, RAS status or MSI-H were not associated with ECOG 2-3 status. In ECOG 0 / 1 / 2-3 median overall survival (OS) was 46.0 / 29.1 / 13.2 months and progression free survival (PFS) 18.6 / 12.5 / 7.0 months, respectively. Cox proportional hazards models for OS and PFS suggested that baseline ECOG 2-3, bone metastases, BRAF mutation, >3 metastatic sites, elevated ALP or leukocytes were the strongest predictors of poor OS and PFS. Conclusions: Poor performance status is characterized by comorbidities, drinking and smoking; cancer-related symptoms, tumour burden, laboratory alterations and inflam-matory activity. ECOG 2-3 is one of the strongest prognostic factors, and OS is shortened by > 12 months per ECOG class and PFS by 6 months. Clinical trial identification: NCT01531621. Legal entity responsible for the study: The authors of the RAXO-study group.