prognosis of colon cancer compared with rectal cancer. where lies the difference?

Prognosis of colon cancer compared with rectal cancer. Where lies the difference?

Bjørn S. Nedrebø

Stavanger University Hospital

Aim of the lecture

• Compare colon and rectal cancer in Norway

• Point out differences, short term and long term

• Quality of the surgical specimen of colon cancers in Norway

3

National Registry Introduction TME

1993/94

Colon CancerColon Cancer

Rx

T4, fixed

20001997

Cx

Stage III≤75 yrs

2003

MRI stagingCRM ≤3 mm

MDT

Rectal CancerRectal CancerColorectal Cancer in Norway

Evolution of Treatment RecommendationsColorectal Cancer in Norway

Evolution of Treatment Recommendations

N=31158 (100%)Metachronous

cancer; n=1486 (5%)N=29672( 95%)

N=20648 (66%)

Metastases; n=9024 (29%)

Minor resections;N=1595 (5%)

Study populationN=19053 (61%)

Patient Cohort

Norwegian Cancer Registry & Rectal Cancer Registry, 1994 – 2003

Method

• 5 year relative survival for all patients

• Excess mortality in different timeperiods

• Time periods(1) 1994-1996 (N=5400) (2) 2001-2003 (N=5870)

70% Colon cancer in both periods

Analysis

– Localisation• Rectum (≤ 15 cm from anal verge)• Colon

– Stage• N0 (T1-4, N0)

• N+ (T1-4, N1-2)

– Age: <75 vs. ≥75 year

Patient Characteristics

Improved survivalColon and rectal cancer

p<0.01 p<0.01

Colon Rektum

1994-1996

2001-2003

Fig 1 a-b: Early studyperiod vs late studyperiod

1a Colon cancer 1b Rectal cancer

Colon vs rectum

p<0.74 p<0.03

Early period Late period

ColonRectum

Fig 2 a-b. Coloncancer vs rectumcancer

2a Early period 2b Late period

Colon early vs late

N0 N+

1994-1996

2001-2003

Rectal cancer, early vs late

N0 N+

1994-1996

2001-2003

N+

Lymph node sampling as a proxy of surgical technique

• Included all patients in Norway 2007-2008 who were operated for adenocarcinoma in colon

• Lymph node sampling; % operations with ≥12 lymph nodes.

• 5068 coloncancer (100%)• 4145 (81%) underwent surgical resection.• 3733 patients (73%) with complete histopathologydata

• 73% ≥ 12 lymph nodes• 16% laparoscopy

Age

Age N ≥12 lymph nodes

<65 26% 74%

65-69 13% 74%

70-74 15% 66%

75-79 17% 66%

80-84 16% 65%

>85 13% 66%

Sex/localisation

Sex N ≥ 12 lymph nodes

Male 47% 67%

Female 53% 70%

Right colon 56% 74%

Left colon 44% 63%

Hospital volume

Hospital volume / year N % ≥ 12 lymph nodes

>60 59% 71%

40-59 26% 69%

20-39 5% 58%

10-20 7% 66%

<10 3% 60%

Elective vs acute

N ≥ 12 lymph nodes

Elective 84% 72%

Acute w/ obstruction 11% 64%

Acute w/ perforation <1% 64%

Multivariatanalyse

• ≥12 lymph nodes:

• Pasient <70 years

• Elective surgery

• High volume hospital

• pT >1

• Right sided resection

• Pathological template

Conclusion

Better survival for rectal cancer than colon cancerNeed to focus on colon cancer, especially

patients over 75 years

acute surgery

high volume hospitals(?)

standardised pathology template