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Prognostic Impact of Hypochloremia in Patients With Stage I to III Colorectal Cancer After Radical Resection

Li, Qingguo, M.D., Ph.D.1,2; Dai, Weixing, M.D.1,2; Jia, Huixun, M.D.2,3; Li, Yaqi, M.D.1,2; Xu, Ye, M.D., Ph.D.1,2; Li, Xinxiang, M.D., Ph.D.1,2; Cai, Guoxiang, M.D.1,2; Cai, Sanjun, M.D., Ph.D.1,2

doi: 10.1097/DCR.0000000000001196
Original Contributions: Colorectal Cancer
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BACKGROUND: Recent studies have suggested that electrolyte disorders might be a negative prognostic factor for some diseases.

OBJECTIVE: The purpose of this study was to systematically evaluate the prognostic role of electrolyte disorders in patients with stage I to III colorectal cancer who received radical surgical resection.

DESIGN: This study was retrospectively performed.

SETTINGS: The study was conducted at a single tertiary care center.

PATIENTS: Patients with colorectal cancer who underwent radical resection in between April 2007 and April 2014 were included.

MAIN OUTCOME MEASURES: The Kaplan–Meier method was adopted to estimate the overall and disease-free survival with and without propensity score matching.

RESULTS: In total, our study recruited 5089 eligible patients. In prematching analysis, patients with hypochloremia showed both shorter overall survival (HR = 0.943 (95% CI, 0.908–0.980); p = 0.003) and disease-free survival (HR = 0.957 (95% CI, 0.933–0.981); p < 0.001) than those with normal serum chloride levels. In postmatching analysis, 770 patients from each group were compared, and the results further confirmed that hypochloremia was significantly associated with worse overall survival (HR = 0.646 (95% CI, 0.489–0.855); p = 0.002) and disease-free survival (HR = 0.782 (95% CI, 0.647–0.944); p = 0.01), with the hypochloremia group as a reference.

LIMITATIONS: The study was limited by its retrospective nature.

CONCLUSIONS: Hypochloremia diagnosed before treatment can independently prognosticate the overall and disease-free survival for patients with stage I to Ш colorectal cancer after radical resection. Intensive surveillance and management might improve the survival outcome for patients with hypochloremia. See Video Abstract at

1 Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

3 Center for Biomedical Statistical, Fudan University Shanghai Cancer Center, Shanghai, China

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: This study was partially supported by grants from the National Science Foundation of China (Nos. 81372646, 81101586, and 81472222), Shanghai Municipal Natural Science Foundation (17ZR1406400), and Shanghai Rising-Star Program (17QA1400900).

Financial Disclosure: None reported.

Qingguo Li, Weixing Dai, and Huixun Jia contributed equally to this work.

Correspondence: Sanjun Cai, M.D., Ph.D., Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Rd, Shanghai 20032, China. E-mail: or Guoxiang Cai, M.D.,, or Xinxiang Li, M.D.,

© 2018 The American Society of Colon and Rectal Surgeons