Article

Continued progress with stage III colorectal cancer--a triple cohort study.

Colorectal Unit, Department of Surgery, PO Box 4345, Christchurch Hospital, Christchurch 8013, New Zealand. .
The New Zealand medical journal 01/2013; 126(1382):11-24.
Source: PubMed

ABSTRACT Colorectal cancer is a common cause of death in New Zealand and its burden is projected to increase in the future. Oncological outcomes from modern treatment have improved, but evidence from the published literature is conflicting. We studied survival outcomes from a series of patients at our local health board.
A retrospective analysis of disease patterns, surgical procedures, adjuvant therapy and oncological outcomes was performed in three patient cohorts; January 1993-December 1994, January 1998-June 1999, and January 2004-December 2005 at Christchurch Hospital. Univariate, multivariate and Kaplan-Meier survival analysis was performed to identify differences between the three cohorts.
There were 1091 patients [(355, 317, 419 per cohort, 808 colon (281,227,300) and 283 rectal (74,90,119)] with cancer over the 3 cohorts. Median age was 76 (IQR 67-84) years. Median follow-up was 44 (IQR 13-81) months. For both colon and rectal cancer, patients in later cohorts had early disease, were more likely to have the operation performed by a consultant, were more likely to be referred for an oncological opinion and were more likely to receive adjuvant treatment (p<0.05 respectively). Differences in survival were particularly marked in the later cohort of patients with Stage III colonic cancer.
There have been significant improvements in oncological outcome with stage three colon and rectal cancer over the study period. Greater specialisation of surgeons, more operations by consultants and use of chemotherapy are all likely contributing factors.

1 Follower
 · 
45 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The association between socioeconomic status (SES) and relative survival of rectal cancer is little investigated. We hypothesized that the impact on risk of death by SES would be much smaller when differences in background mortality (comorbidity, lifestyle factors) were taken into account, i.e. in modelling relative survival of rectal cancer. Individual data on civil status, education, and income were linked to the Swedish Rectal Cancer Registry 1995-2005 (n = 16,713). Specific life tables by socioeconomic group were used to calculate relative survival, and modelling included age, sex, stage, time period, and SES. The same covariates were applied in a Cox regression based on absolute survival. Stage distribution was associated with civil status, education, and income (p < 0.001). In spite of modelling based on relative survival, an increased risk of death was found for all other patients compared with those who were married, as well as for all other patients compared with those with the highest income. The pattern was fundamentally the same as in a Cox regression model, only the point estimates were slightly reduced using the relative approach. In stage-specific modelling of relative survival, income was of particular importance in stage III; the hazard ratio (HR) for lowest versus the highest income was 1.37 [95 % confidence interval (CI) 1.15-1.64]. There were also significant differences by income among patients who had a major surgical resection (stage IV excluded). Large and clinically relevant socioeconomic inequalities remained in stage-adjusted analyses of relative survival, also in a setting of universal healthcare and no screening program operating.
    World Journal of Surgery 09/2014; 38(12). DOI:10.1007/s00268-014-2735-4 · 2.35 Impact Factor

Full-text

Download
35 Downloads
Available from
Jun 6, 2014