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