Acute bacterial infection negatively impacts cancer specific survival of colorectal cancer patients

Abstract

Aim: To assess the impact of bacterial infections on cancer-specific survival in patients with colorectal cancer.

Methods: This was a retrospective cohort study of colorectal cancer patients treated at the A.C. Camargo Cancer Center between January 2006 and April 2010. The presence of bacterial infection during cancer treatment, or up to one year after, was confirmed by laboratory tests or by the physician. Infections of the urinary, respiratory or digestive tracts, bloodstream, skin or surgical site were defined by testing within a single laboratory. Criteria for exclusion from the study were: chronically immunosuppressed patients; transplant patients (due to chronic immunosuppression); human immunodeficiency virus carriers; chronic use of corticosteroids or other immunosuppressive drugs; patients with autoimmune disease or primary immunodeficiency; known viral or parasitic infections. Patients with infections that did not require hospitalization were not included in the study because of the difficulty of collecting and tracking data related to infectious processes. In addition, patients hospitalized for pulmonary thromboembolism, stroke, acute myocardial infarction, uncontrolled diabetes, malignant hypercalcemia or other serious non-infectious complications not directly related to infection were also excluded. Survival curves were plotted using the Kaplan-Meier method, and log-rank tests (univariate analysis) and a Cox test assuming a proportional hazards model (multivariate analysis) were performed to examine associations between clinical history and characteristics of infection with cancer-specific survival.

Results: One-hundred and six patients with colorectal cancer were divided into two groups based on the presence or absence of bacterial infection. Patient ages ranged from 23 to 91 years, with a median of 55 years. The majority of patients were male (57/106, 53.77%) with stage III colorectal cancer (45/106, 44.11%). A total of 86 bacteriologic events were recorded. Results indicate that the presence and number of infections during or after the end of treatment were associated with poorer-cancer specific survivals (P = 0.02). Elevated neutrophil counts were also associated with poorer cancer-specific survival (P = 0.02). Analysis of patient age revealed that patients > 65 years of age had a poorer cancer-specific survival (P = 0.04). A multivariate analysis demonstrated that infection was an independent predictor of poor survival (HR = 2.62, 95%CI: 1.26-5.45; P = 0.01) along with advanced clinical staging (HR = 2.63, 95%CI: 1.08-6.39; P = 0.03).

Conclusion: Infection and high neutrophil counts are associated with a poorer cancer-specific survival in colorectal cancer patients.

Keywords: Bacterial infections; Colorectal cancer; Survival.

Figure 1

Cancer specific survival. Curves were calculated by Kaplan-Meier method and compared log-rank test. A: Cancer specific survival according to the occurrence of infection in colorectal cancer patients. The red line corresponds to patients who had at least one infection and the black line to those who did not have any infection; B: Cancer specific survival in colorectal cancer patients, according to the number of infections. The red line refers to patients who had one infection only, the green line to those who had two or more infections and the black line to patients who did not have any infection; C: Cancer specific survival in colorectal cancer patients according to the presence or absence of neutrophilia. The red line refers to those patients who did not develop neutrophilia, the green line corresponds to those who developed neutrophilia and the black line refers to patients from the control group; D: Cancer specific survival according to age for colorectal cancer. The black line corresponds to the patients under 65 years and red line corresponds to the patients with age equal or greater than 65 years.