Independent Prognostic Significance of Perforation in Colorectal Cancer: Insights From a Propensity Score-Matched Cohort Study.

AIM: Although perforated colorectal cancer has a poor prognosis, it remains unclear whether this is attributed to the perforation itself or related clinicopathological factors indicating advanced tumor progression. We investigated the true prognostic impact of perforation in colorectal cancer after adjusting for perforation-related clinicopathological factors.

METHODS

This retrospective single-center cohort study included 2073 patients underwent curative resection for primary colorectal cancer between January 2009 and December 2022 (73 with perforated colorectal cancer and 2000 with nonperforated colorectal cancer). Perforation-related clinicopathological factors were identified by multivariate logistic regression and used for 1:2 propensity score matching as covariates. Recurrence-free survival and overall survival were analyzed using Kaplan-Meier estimates and Cox proportional hazards models.

RESULTS

Independent perforation-related clinicopathological factors were age ≥ 75 years, left-sided tumor, and pathological T Stage 4 (pT4). The perforated colorectal cancer group had a lower rate of minimally invasive surgery (62.5% vs. 90.6%), fewer harvested lymph nodes (medians: 13 vs. 16.5), and more frequent major postoperative complications (18.8% vs. 7.3%) compared to the nonperforated colorectal cancer group. Multivariate Cox analysis revealed that pT4 and perforation independently predicted worse recurrence-free survival and overall survival. The hazard ratios were 2.71 and 2.54 for pT4 (95% confidence intervals: 1.45-5.04 and 1.08-5.9), and 2.67 and 3.30 for perforation (95% confidence intervals: 1.44-4.96 and 1.37-7.96), respectively.

CONCLUSION

Perforation independently predicted poor prognosis in colorectal cancer, highlighting its distinct oncologic relevance beyond standard pathological staging. Prospective studies should establish individualized strategies to improve outcomes in perforated colorectal cancer.