{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T09:14:34Z","timestamp":1774170874241,"version":"3.50.1"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,2,5]],"date-time":"2015-02-05T00:00:00Z","timestamp":1423094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,2,5]],"date-time":"2015-02-05T00:00:00Z","timestamp":1423094400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Surgical audit is an essential task for the estimation of postoperative outcome and comparison of quality of care. Previous studies on surgical audits focused on short\u2010term outcomes, such as postoperative mortality. We propose a surgical audit evaluating long\u2010term outcome following colorectal cancer surgery. The predictive model for this audit is designated as \u2018Estimation of Postoperative Overall Survival for Colorectal Cancer (EPOS\u2010CC)\u2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010one tumor\u2010related and physiological variables were prospectively collected in 889 patients undergoing elective resection for colorectal cancer between April 2005 and April 2007\u00a0in 16\u00a0Japanese hospitals. Postoperative overall survival was assessed over a 5\u2010years period. The EPOS\u2010CC score was established by selecting significant variables in a uni\u2010 and multivariate analysis and allocating a risk\u2010adjusted multiplication factor to each variable using Cox regression analysis. For validation, the EPOS\u2010CC score was compared to the predictive power of UICC stage. Inter\u2010hospital variability of the observed\u2010to\u2010estimated 5\u2010years survival was assessed to estimate quality of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 889 patients, 804 (90 %) completed the 5\u2010years follow\u2010up. Univariate analysis displayed a significant correlation with 5\u2010years survival for 14\u00a0physiological and nine tumor\u2010related variables (<jats:italic>p<\/jats:italic> &lt; 0.005). Highly significant <jats:italic>p<\/jats:italic>\u2010values below 0.0001 were found for age, ASA score, severe pulmonary disease, respiratory history, performance status, hypoalbuminemia, alteration of hemoglobin, serum sodium level, and for all histological variables except tumor location. Age, TNM stage, lymphatic invasion, performance status, and serum sodium level were independent variables in the multivariate analysis and were entered the EPOS\u2010CC model for the prediction of survival. Risk\u2010adjusted multiplication factors between 1.5 (distant metastasis) and 0.16 (serum sodium level) were accorded to the different variables. The predictive power of EPOS\u2010CC was superior to the one of UICC stage; area under the curve 0.87, 95 % CI 0.85\u20130.90 for EPOS\u2010CC, and 0.80, 0.76\u20130.83 for UICC stage, <jats:italic>p<\/jats:italic> &lt; 0.001. Quality of care did not differ between hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The EPOS\u2010CC score including the independent variables age, performance status, serum sodium level, TNM stage, and lymphatic invasion is superior to the UICC stage in the prediction of 5\u2010years overall survival. This higher accuracy might be explained by the inclusion of physiological factors, thus also taking non\u2010tumor\u2010associated deaths into account. Furthermore, EPOS\u2010CC score may compare quality of care among different institutions. Future studies are necessary to further evaluate this score and help improving the prediction of long\u2010term survival following colorectal cancer surgery.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-015-2962-3","type":"journal-article","created":{"date-parts":[[2015,2,4]],"date-time":"2015-02-04T14:18:33Z","timestamp":1423059513000},"page":"1567-1577","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The EPOS\u2010CC Score: An Integration of Independent, Tumor\u2010 and Patient\u2010Associated Risk Factors to Predict 5\u2010years Overall Survival Following Colorectal Cancer Surgery"],"prefix":"10.1002","volume":"39","author":[{"given":"Yoshio","family":"Haga","sequence":"first","affiliation":[{"name":"Institute for Clinical Research National Hospital Organization Kumamoto Medical Center 1\u20105 Ninomaru 8600008 Chuo\u2010Ku Kumamoto Japan"},{"name":"Department of International Medical Cooperation, Graduate School of Medical Sciences Kumamoto University 1\u20101\u20101 Honjo 8608556 Chuo\u2010Ku Kumamoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Ikejiri","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Kyushu Medical Center 1\u20108\u20101 Jigohama 8108563 Chuo\u2010Ku Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuo","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Himeji Medical Center 68 Honmachi 6708520 Himeji Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Ikenaga","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Osaka National Hospital 2\u20101\u201014, Hoenzaka 5400006 Chuo\u2010Ku Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoichiro","family":"Koike","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Matsumoto Medical Center 2\u201020\u201030 Muraimachiminami 3998701 Matsumoto Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiji","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Takasaki General Medical Center 36 Takamatsu\u2010cho 3700829 Takasaki Gunma Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masato","family":"Koseki","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Kure Medical Center 3\u20101 Aoyama\u2010cho 7370023 Kure Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,2,5]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800780327"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199810000\u201000006"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200209000\u201000011"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181823485"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02483010"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.4.481"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2003.11.012"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181f66199"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e3182271a54"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10120\u2010011\u20100052\u20102"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23160"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102383\u20100"},{"key":"e_1_2_7_14_2","doi-asserted-by":"crossref","unstructured":"HagaY WadaY SaitohTet al. 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