Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer

Objective: To evaluate the prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer and create statistically distinct prognostic groups of colorectal cancer patients based on clinical and nutritional variables. Design: A retrospective clinical epidemiologic study. Setting: A private tertiary care American Cancer Center. Subjects: In total, 234 colorectal cancer patients aged 29 - 82 y treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. Intervention: SGA Questionnaire. SGA A - well nourished; SGA B - moderately malnourished; and SGA C - severely malnourished. Malnutrition was defined as either SGA B or SGA C. Results: The prevalence of malnutrition in this patient population, as determined by SGA, was 52% (113/217). The median survival of patients with SGA A was 12.8 months (95% CI; 9.1 - 16.5), those with SGA B was 8.8 months ( 95% CI; 6.7 - 10.9) and those with SGA C was 6 months ( 95% CI; 3.9 - 8.1); the difference being statistically significant at P = 0.0013. Regression tree analysis identified prior treatment history, lactate dehydrogenase (LDH) and SGA to be important predictors of survival for our patient cohort. Patients with no prior treatment history ( newly diagnosed disease), low LDH scores, and SGA A had the best overall survival of 40.4 months ( 95% CI; 30.45 - 50.4), whereas patients with prior treatment history ( progressive disease), high LDH scores, and SGA B/C had the worst overall survival of 4.5 months ( 95% CI; 2.22 - 6.76). Conclusion: The SGA provides useful prognostic information in patients with advanced colorectal cancer. Sponsors: Cancer Treatment Centers of America.