Survival of colorectal cancer patients in Europe during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with colorectal cancer. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 47 and 43% for cancers of the colon and rectum, respectively. Survival decreased with increasing age: the relative risk of dying for the oldest patients (75+) was 1.39 for rectum and 1.54 for colon compared with the youngest patients (15–44 years). In 1985–1989 survival from colorectal cancer differed significantly between different European countries: the Nordic countries (Denmark excluded), The Netherlands, Switzerland, France and Austria were characterised by high survival, whilst Eastern European countries, the U.K. and Denmark were characterised by low survival. There was a general improvement in survival over the period 1978–1989: from 40 to 48% for colon cancer and 38 to 46% for rectal cancer. For neither cancer site did between-country survival differences narrow over the study period. Intercountry and time differences in survival differences are probably related to stage at diagnosis and postoperative mortality.     

Variation in survival of patients with prostate cancer in Europe since 1978

Since the incidence of prostate cancer has increased considerably over the past two decades in most European countries, knowledge of the variation in survival is pertinent. The collaboration across Europe in the EUROCARE study has now been extended to 45 registries in 17 countries. We report on variation in relative survival according to age of 65 728 patients diagnosed with prostate cancer between 1985 and 1989 and also explore time trends since 1978 for most countries. Considerable variation in survival was found within and between countries, with the highest survival in Switzerland (5-year relative survival 72%), followed by Germany (67%) and the Nordic countries (except Denmark). The lowest survival was found in Estonia (39%), preceded by Slovenia (40%), Denmark (41%) and England (45%). Between 1978 and 1986, relative survival barely changed over time, but it improved from 55% (95% confidence interval [CI] 53–57) during 1984–1986 to 59% (CI 56–61) during 1987–1989. A small but unexpected deterioration of survival for patients aged between 45 and 54 years from 61% to 56% was observed in the early 1980s. It is likely that variation in both detection methods and treatment plays a role in the observed variation in survival, but more information is needed to assess each contribution.     

Variations in survival from breast cancer in Europe by age and country, 1978–1989

The objective of this study, part of the wider EUROCARE II collaborative project, was to examine variations by age and country in the relative survival of women from breast cancer in Europe, based on data for 145 000 cases in 1985–1989 and trends based on (245 000) cases for 1978–1989. Data were supplied by 42 cancer registries in 17 countries to a common protocol. Results for some countries where the participating registries covered only small proportions of the total population may not be representative of the whole country. In 1985–1989 there were wide differences among the 17 countries: survival was above the European average in Iceland, Finland, Sweden, Switzerland, France and Italy; around average in Denmark, The Netherlands, Germany and Spain; below average in Scotland, England and Slovenia; and well below average in Slovakia, Poland and Estonia. In France, Spain and Italy, but not in the U.K., there were wide differences in survival among the participating registries. Survival generally declined with age, particularly in the elderly (75 years and over)—this was most marked in Denmark, Scotland and England. Over the period 1978–1989, 1-year survival improved by 2% overall and 5-year survival by 6%. There were improvements in 5-year survival in all countries except Iceland, Germany, Switzerland and Estonia, and in all age groups except the youngest (15–44 years). It is likely that differences in the access to and quality of care in the various countries played a large part in explaining the differences in survival.     

Survival of European women with gynaecological tumours, during the period 1978–1989

This study concerns the survival of European patients diagnosed between 1978 and 1989 with cancer of corpus and cervix uteri and ovary. Variations in survival in relation to age, country and period of diagnosis were examined. Data from the EUROCARE study were supplied by population-based cancer registries in 17 countries to a common protocol. Five years after diagnosis, relative survival rates were 75, 62 and 35% for cancers of the endometrium, cervix and ovary, respectively. Survival decreased markedly with age. The decrease was especially evident for ovarian cancer, which declined from 65% (15–45 years) to 18% (75+ years). In 1985–1989 there were important inter-country differences in survival for European women with gynaecological cancers: Eastern European countries were characterised by low 5-year relative survival whilst in Sweden, Austria, The Netherlands and Switzerland survival was generally higher than for other European countries. From 1978–1989, 5-year relative survival improved slightly for cervical cancer and improved more among the oldest patients. Prognosis also improved slightly for patients with ovarian tumours and this increase (around 20%) was concentrated among patients between 15 and 64 years of age. Intercountry differences in survival did not in general reduce over time, although for ovarian cancer survival differences narrowed probably in relation to the more widespread use of more effective chemotherapy. Intercountry and time differences in survival for cervical cancer are almost certainly related to variations in the effectiveness of cervical screening programmes. For corpus uteri cancer there was no improvement in survival over the period of this study and intercountry survival differences for this cancer are probably related to differences in patient management.     

Variation in survival for adults with Nasopharyngeal cancer in Europe, 1978–1989

During the period 1978-1989, 2,054 new patients with nasopharyngeal carcinoma (NPC) were registered in the EUROCARE study, which, during 1985-1989 involved 45 population-based cancer registries in 17 countries. The follow-up time was at least 5 years. 48% of all cases were squamous cell carcinomas and 39% undifferentiated carcinomas, which were more frequent in males. The overall relative 1- and 5-year survival rates (data included from 8 countries with complete data) were 75 and 34%, respectively, for males, and 72 and 32%, respectively, for females, but in a multivariate analysis, there was no significant difference in risk between males and females (0.93 (0.84-1.01), hazard ratio (HR) with 95% confidence interval (95% CI) for females). The overall relative 5-year survival (data included from nine countries with complete data) declined with age, from 53% for patients aged 15-44 years to 31% for patients aged 65-74 years. For patients with undifferentiated tumours, higher survival rates were observed in Scandinavia, Slovakia and Mediterranean countries, with lower rates for patients from the U.K. and Estonia. Survival for patients with squamous cell carcinoma was lowest in Scotland, England and Estonia. In a multivariate analysis, there was a significant difference in risk of death between those with squamous cell carcinomas and those with undifferentiated (HR 0.82, 95% CI 0.74-0.90). Between 1978 and 1989, the prognosis did not change.     

Survival rates for primary malignant brain tumours in Europe

In the framework of EUROCARE, a concerted action between 45 population-based cancer registries, in 17 European countries, survival of patients with primary malignant brain tumours was investigated. Survival analysis was carried out on 16 268 patients diagnosed between 1985 and 1989 and followed-up for at least 5 years. The mean European age-standardised 5-year relative survival was 17% in men and 20% in women, with minimal intercountry variations, except for markedly lower rates in Scotland, Estonia and Poland. The age-specific analysis showed a relatively uniform survival in patients aged more than 65 years at diagnosis, but there were more marked intercountry differences in younger patients. In the 15–44 year age group (25% of the total study population) 5-year relative survival ranged between 55% (Finland and Sweden) and 27% (Poland). Generally, survival decreased with increasing age at diagnosis. The analysis of a temporal trend in survival was carried out on a subset of registries with available data from 1978–1989. Overall, there was an increase in survival over the considered study period, mostly confined to 1-year survival, suggesting that it was mostly related to improved diagnostic techniques. The most important survival increase occurred in the younger patients, both for 1- and 5-year survival, suggesting that younger patients have less biologically aggressive tumours, benefiting from the combined effect of diagnostic accuracy and effective therapies. The most marked survival increase was seen in England and Denmark, countries with low survival rates at the beginning of the study period, whereas in Finland and Germany, where survival was relatively high to begin with, no important temporal trend was seen.     

Up-to-date monitoring of childhood cancer long-term survival in Europe: central nervous system tumours

Background: Tumours of the central nervous system (CNS) accountfor 15–20% of all malignant childhood tumours in developedcountries. Steady improvement of survival of children with CNStumours has been reported for the past decades. However, theseresults, obtained by cohort analysis of survival, do not reflectthe full extent of recent improvement. Methods: Using selected registries from the database of theAutomated Childhood Cancer Information System (ACCIS), we calculatedperiod survival estimates for the years 1995–99 for childrendiagnosed with a malignant CNS tumour. Results: The overall 10-year period survival estimate for theyears 1995–99 was 59% for children with all CNS tumourscombined, 73% for children with astrocytoma, 53% for childrenwith ependymoma and 45% for children with primitive neuroectodermaltumours. On average, estimates derived by cohort analysis (pertainingto children diagnosed in 1985–89) were around 4% unitslower. Region-specific analysis revealed that recent progresswas largest in Eastern Europe, where prognosis neverthelessremained lower than in other European regions. In Northern andSouthern Europe, 10-year survival remained essentially unchanged. Conclusion: Although period survival of children with CNS tumoursis higher than previously reported cohort survival, their long-termprognosis remains modest compared to other childhood malignancies. Key words: cancer registries, childhood cancer, CNS tumours, Europe, population-based, prognosis, survival Received for publication November 17, 2006. Revision received April 4, 2007. Accepted for publication April 11, 2007.     

Survival of patients with primary liver cancer, pancreatic cancer and biliary tract cancer in Europe

The EUROCARE Study is a European Union project to assemble survival data from population-based cancer registries and analyse them according to standard procedures. We investigated and compared liver, pancreatic and biliary tract cancer survival in 17 countries from 1985 to 1989. Time trends in survival over the 1978–1989 period were also investigated in 12 countries. The overall European mean 1 year relative survival was 16% for primary liver cancer, 26% for biliary tract cancer and 15% for pancreatic cancer. The corresponding 5-year relative survival was 5, 12 and 4%, respectively. Taking the European average as the reference, the relative risk (RR) of death was at least 20% higher for the three cancers in Denmark and Estonia. Survival tended to be higher in Spain for primary liver cancer and biliary tract cancer. Gender had little influence on survival whilst age at diagnosis was inversely related to prognosis. There was an improvement in 1-year relative survival rate for primary liver cancer: relative risk (RR) of 0.68 (95% confidence interval (CI) of 0.60–0.77) for 1987–1989 versus 1978–1980 and biliary tract cancer (RR 0.77, 95% CI 0.68–0.87). There was less variation in 5-year relative survival rate over time. Some intercountry survival differences for primary liver, biliary tract and pancreatic cancers exist over Europe. Differences in quality of care, in particular treatment aggressiveness, may explain some of these differences in survival. New approaches to the management of these cancers need to be found.     

Variation in survival of patients with lung cancer in Europe, 1985–1989

In this study, we report on the variation in the prognosis for adult patients with lung cancer within Europe, by age, histology and country from 1985–1989. We considered trends in survival since 1978 for most countries. Survival analysis was carried out on 173 448 lung cancer cases diagnosed between 1985 and 1989 in 44 population-based cancer registries, participating in the EUROCARE study. Relative 1-year survival rates for patients with lung cancer varied from 24 to 40%, being highest in Finland, France, The Netherlands and Switzerland and lowest in Denmark, England, Poland and Scotland. Half of all patients under the age of 45 years died within 1 year of diagnosis, increasing to almost 80% for those aged 75 years or older. Whilst the prognosis for patients with non-small cell carcinoma remained more or less constant between 1978 and 1989 (25% in Denmark and 44% in Finland), that for patients with small cell carcinoma improved slightly, especially in The Netherlands (Eindhoven from 17 to 24%) and Switzerland (Geneva from 24 to 32%). In conclusion, a fairly large variation in lung cancer relative survival rates existed between European countries. The most likely explanation for the differences is the variation in access to specialised care. Except for a slight improvement in short-term survival for patients with small cell lung cancer, survival has remained poor since 1978.     

Relative survival in elderly cancer patients in Europe

In this paper different patterns of survival by age and gender are presented for 17 European countries which participated in the EUROCARE II programme. Survival data were available for 701521 patients aged between 65 and 99 years from 44 population-based cancer registries. Age-standardised relative survival rates at 1 and 5 years from diagnosis were computed. Relative risks (RRs) of death for those aged between 65 and 99 years compared with those aged between 55 and 64 years were estimated by gender and country. In general, the elderly had a large survival disadvantage, particularly 1 year after diagnosis and in women. Poorer survival rates in the elderly were observed for patients from Eastern European countries for almost all sites. However, relative survival of the elderly with respect to younger patients was similar in the different geographic areas. The results are in agreement with other population-based studies, confirming a worse prognosis for the elderly in both sexes. This may be explained by changes in biology and the natural history of the tumour and the occurrence of severe comorbidities, potentially affecting preventive, diagnostic and therapeutic strategies. The lack of equality in providing adequate treatment to elderly cancer patients should be addressed as a matter of urgency by health-care providers.     

Recent trends in colorectal cancer mortality in Europe

Colorectal cancer mortality has been declining over the last two decades in Europe, particularly in women, the trends being, however, different across countries and age groups. We updated to 2007 colorectal cancer mortality trends in Europe using data from the World Health Organization (WHO). Rates were analyzed for the overall population and separately in young, middle‐age and elderly populations. In the European Union (EU), between 1997 and 2007 mortality from colorectal cancer declined by around 2% per year, from 19.7 to 17.4/100,000 men (world standardized rates) and from 12.5 to 10.5/100,000 women. Persisting favorable trends were observed in countries of western and northern Europe, while there were more recent declines in several countries of eastern Europe, including the Czech Republic, Hungary and Slovakia particularly in women (but not Romania and the Russian Federation). In 2007, a substantial excess in colorectal cancer mortality was still observed in Slovakia, Hungary, Croatia, the Czech Republic and Slovenia in men (rates over 25/100,000), and in Hungary, Norway, Denmark and Slovakia in women (rates over 14/100,000). Colorectal mortality trends were more favorable in the young (30–49 years) from most European countries, with a decline of ～2% per year since the early 1990s in both men and women from the EU. The recent decreases in colorectal mortality rates in several European countries are likely due to improvements in (early) diagnosis and treatment, with a consequent higher survival from the disease. Interventions to further reduce colorectal cancer burden are, however, still warranted, particularly in eastern European countries.     

Variations in survival for invasive cervical cancer among European women, 1978–89

Objectives: To analyze cervical cancer survival trends in 10 European countries using models that estimate the proportion of cured patients (having the same life expectancy as the general population) and the survival of fatal cases (who die from cervical cancer).Methods: We considered 40,906 cases diagnosed over 12 years (1978–89) collected from cancer registries participating in EUROCARE.Results: From 1978 to 1989, 5-year relative survival in Europe improved (60%63%). The proportion of cured patients increased slightly but significantly (53%55%, p=0.05). For countries with poorer survival at the end of the 1970s the proportion of cured patients increased faster than average, particularly evident in England (49%56%) and Scotland (44%53%). By contrast, in Finland, Sweden and Germany with organized screening, 5-year survival and cure rate did not improve, but incidence declined to very low levels.Conclusions: Cervical screening can explain the trends in cervical cancer survival: this identifies premalignant lesions, reduces incidence and selectively prevents less aggressive cancers. The decreased proportion of the latter means that survival does not improve in countries with low incidence of cervical cancer. The increased proportion of cured patients with time shows that survival improvement was not due simply to earlier diagnosis with no patient advantage.     

Differences in stage and therapy for breast cancer across Europe

We examined variations in stage, diagnostic workup and therapy for breast cancer across Europe. Seventeen cancer registries in six European countries contributed 4,480 cases diagnosed in 1990-91. The clinical records of these cases were examined, and the distribution of stage, diagnostic examinations and therapy were analyzed. Stage was earliest in the French registries, followed by those of Italy and Eindhoven (Netherlands). The proportion of stage I cancers was highest in the French areas with screening in place. Estonia, the English registries and Granada (Spain) had the most advanced stage at diagnosis. Use of liver ultrasonography varied from 84% (Italian registries) to 18% (Granada). Bone scan use varied from 81% (Italian registries) to 15% (Mersey, UK). The highest proportions treated by breast-conserving surgery were in the French (57%) and English registries (63%); the lowest were in Estonia (6%) and Granada (11%). The highest proportions of Halsted mastectomies were in Italy (19%) and Granada (8%). In all countries except England, 90% of operations included axillary lymphadenectomy. Medical treatment only was given to 8% of (mostly advanced) cases overall. Estonia (21%) and the English registries (14%) had the highest proportions of patients given medication only. Chemotherapy was given to low proportions of node-positive cases in the Italian (76%) and English (74%) areas; breast-conserving surgery for stage I tumors varied from 24% in Granada to 84% in England. These wide differences in breast cancer care across Europe in the early 1990s indicate a need for continual monitoring of past treatments to help ensure application of the most effective protocols.     

Progress in colorectal cancer survival in Europe from the late 1980s to the early 21st century: the EUROCARE study

Colorectal cancer (CRC) is the second most common cause of death due to cancer causing death in Europe, accounting for more than 200,000 deaths per year. Prognosis strongly depends on stage at diagnosis, and the disease can be cured in most cases if diagnosed at an early stage. We aimed to assess trends and recent developments in 5-year relative survival in European countries, with a special focus on age, stage at diagnosis and anatomical cancer subsite. Data from 25 population-based cancer registries from 16 European countries collected in the context of the EUROCARE-4 project were analyzed. Using period analysis, age-adjusted and age-specific 5-year relative survival was calculated by country, European region, stage and cancer subsite for time periods from 1988-1990 to 2000-2002. Survival substantially increased over time in all European regions. In general, increases were more pronounced in younger than in older patients, for earlier than for more advanced cancer stages and for rectum than for colon cancer. Substantial variation of CRC survival between European countries and between age groups persisted and even tentatively increased over time. There is a huge potential for reducing the burden of CRC in Europe by more widespread and equal delivery of existing options of effective early detection and curative treatment to the European population.     

Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe

We used multiple regression models to assess the influence of disease stage at diagnosis on the 5‐year relative survival of 4,478 patients diagnosed with breast cancer in 1990–1992. The cases were representative samples from 17 population‐based cancer registries in 6 European countries (Estonia, France, Italy, Netherlands, Spain and UK) that were combined into 9 regional groups based on similar survival. Five‐year relative survival was 79% overall, varying from 98% for early, node‐negative (T1N0M0) tumours; 87% for large, node‐negative (T2‐3N0M0) tumours; 76% for node‐positive (T1‐3N+M0) tumours and 55% for locally advanced (T4NxM0) tumours to 18% for metastatic (M1) tumours and 69% for tumours of unspecified stage. There was considerable variation across Europe in relative survival within each disease stage, but this was least marked for early node‐negative tumours. Overall 5‐year relative survival was highest in the French group of Bas‐Rhin, Côte d'Or, Hérault and Isère (86%), and lowest in Estonia (66%). These geographic groups were characterised by the highest and lowest percentages of women with early stage disease (T1N0M0: 39% and 9%, respectively). The French, Dutch and Italian groups had the highest percentage of operated cases. The number of axillary nodes examined, a factor influencing nodal status, was highest in Italy and Spain. After adjusting for TNM stage and the number of nodes examined, survival differences were greatly reduced, indicating that for these women, diagnosed with breast cancer in Europe during 1990–1992, the survival differences were mainly due to differences in stage at diagnosis. However, in 3 regional groups, the relative risks of death remained high even after these adjustments, suggesting less than optimal treatment. Screening for breast cancer did not seem to affect the survival patterns once stage had been taken into account. © 2003 Wiley‐Liss, Inc.     

Survival of 86,690 patients with thyroid cancer: A population-based study in 29 European countries from EUROCARE-5

BackgroundIncidence rates of thyroid cancer (TC) increased in several countries during the last 30 years, while mortality rates remained unchanged, raising important questions for treatment and follow-up of TC patients. This study updates population-based estimates of relative survival (RS) after TC diagnosis in Europe by sex, country, age, period and histology.MethodsData from 87 cancer registries in 29 countries were extracted from the EUROCARE-5 dataset. One- and 5-year RS were estimated using the cohort approach for 86,690 adult TC patients diagnosed in 2000–2007 and followed-up to 12/31/2008. RS trends in 1999–2007 and 10-year RS in 2005–2007 were estimated using the period approach.ResultsIn Europe 2000–2007, 5-year RS after TC was 88% in women and 81% in men. Survival rates varied by country and were strongly correlated (Pearson ρ = 75%) with country-specific incidence rates. Five-year RS decreased with age (in women from >95% at age 15–54 to 57% at age 75+), from 98% in women and 94% in men with papillary TC to 14% in women and 12% in men with anaplastic TC. Proportion of papillary TC varied by country and increased over time, while survival rates were similar across areas and periods. In 1999–2007, 5-year RS increased by five percentage points for all TCs but only by two for papillary and by four for follicular TC. Ten-year RS in 2005–2007 was 89% in women and 79% in men.ConclusionsThe reported increasing TC survival trend and differences by area are mainly explained by the varying histological case-mix of cases.     

Survival trends for small intestinal cancer in England and Wales, 1971-1990: national population-based study

This population-based study examines prognostic factors and survival trends among adults (15-99 years) diagnosed with small intestinal cancer in England and Wales during 1971-1990 and followed up to 1995. During this period, the 1- and 5-year age-standardised relative survival rates for small intestinal cancers combined were 42% and 23%, respectively. Duodenal tumours, adenocarcinomas, men, patients with advanced age and the most deprived patients had the poorest prognosis. For all small bowel tumours combined, the excess risk of death fell significantly by 6-9% every 4 years over the 20-year period (adjusted excess hazard ratio (EHR) 0.91 at 1 year after diagnosis, 0.94 at 5 years). For duodenal tumours, the EHR fell by about 14% (95% CI 5-22%) every 4 years between 1979 and 1990, and a similar trend for jejunal tumours was of borderline significance. Further population-based investigations linking survival data to individual data on diagnostic methods and types of treatment are needed.     

Age-related differences in cancer relative survival in the United States: A SEER-18 analysis

Cancer survival has improved since the 1990s, but to different extents across age groups, with a disadvantage for older adults. We aimed to quantify age-related differences in relative survival (RS—1-year and 1-year conditioning on surviving 1 year) for 10 common cancer types by stage at diagnosis. We used data from 18 United States Surveillance Epidemiology and End Results cancer registries and included cancers diagnosed in 2012 to 2016 followed until December 31, 2017. We estimated absolute differences in RS between the 50 to 64 age group and the 75 to 84 age group. The smallest differences were observed for prostate and breast cancers (1.8%-points [95% confidence interval (CI): 1.5-2.1] and 1.9%-points [95% CI: 1.5-2.3], respectively). The largest was for ovarian cancer (27%-points, 95% CI: 24-29). For other cancers, differences ranged between 7 (95% CI: 5-9, esophagus) and 18%-points (95% CI: 17-19, pancreas). Except for pancreatic cancer, cancer type and stage combinations with very high (>95%) or very low (<40%) 1-year RS tended to have smaller age-related differences in survival than those with mid-range prognoses. Age-related differences in 1-year survival conditioning on having survived 1-year were small for most cancer and stage combinations. The broad variation in survival differences by age across cancer types and stages, especially in the first year, age-related differences in survival are likely influenced by amenability to treatment. Future work to measure the extent of age-related differences that are avoidable, and identify how to narrow the survival gap, may have most benefit by prioritizing cancers with relatively large age-related differences in survival (eg, stomach, esophagus, liver and pancreas).     

Time trends of breast cancer survival in Europe in relation to incidence and mortality

Increasing breast cancer survival, observed in most western countries, is not easily interpreted: it could be due to better treatment, more effective treatment due to earlier diagnosis or simply lead-time bias. Increased diagnostic activity (e.g., screening) can inflate both incidence and survival. To understand interrelations between incidence, mortality and survival trends and their consequences, we analyzed survival trends in relation to mortality and incidence. Starting with observed survival from EUROCARE, mortality from WHO and using the MIAMOD method, we estimated breast cancer incidence trends from 1970 to 2005 in 10 European countries. To smooth out peaks in incidence and survival due to early diagnosis activity, survival trends were assumed similar to those observed by EUROCARE in 1983-1994. The following patterns emerged: (1) increasing survival with increasing incidence and declining or stable mortality (Sweden, Finland); (2) slight survival increase, marked incidence increase and slight mortality decrease (Denmark, the Netherlands and France); (3) increasing survival, marked decrease in mortality and tendency to incidence stabilization (UK); (4) marked survival increase, steady or decreasing mortality and moderate increases in incidence (Spain, Italy); (5) stable survival, increasing incidence and mortality (Estonia). In most countries survival increased, indicating a real advantage for patients when accompanied by decreasing or stable mortality, and attributable to improved cancer care (Sweden, UK, France, Italy and Spain). In Finland (with high survival), the Netherlands and Denmark, increasing mortality and incidence indicate increasing breast cancer risk, probably related to life-style factors. In Estonia, low and stable survival in the context of increasing incidence and mortality suggests inadequate care.     

Characteristics affecting survival after locally advanced colorectal cancer in Quebec

BackgroundWe estimated the relations of sociodemographic, organizational, disease, and treatment variables with the risk of death from colorectal cancer (crc) in a Quebec population-based sample of patients with locally advanced crc (lacrc) who underwent tumour resection with curative intent.MethodsInformation from medical records and administrative databases was obtained for a random sample of 633 patients surgically treated for stages ii–iii rectal and stage iii colon cancer and declared to the Quebec cancer registry in 1998 and 2003. We measured personal, disease, and clinical management characteristics, relative survival, and through multivariate modelling, relative excess rate (rer) of death.ResultsThe relative 5- and 10-year survivals in this cohort were 67.7% [95% confidence interval (ci): 65.8% to 69.6%] and 61.2% (95% ci: 58.3% to 64.0%) respectively. Stage T4, stage N2, and emergency rather than elective surgery affected 18%, 24% and 10% of patients respectively. Those disease progression characteristics each independently increased the rer of death by factors of 2 to almost 5. Grade, vascular invasion, and tumour location were also significantly associated with the rer for death. Receiving guideline-adherent treatment was associated with a 60% reduction in the rer for death (0.41; 95% ci: 0.28 to 0.61), an effect that was consistent across age groups. Clear margins (proximal–distal, radial) and clinical trial enrolment were each associated with a nonsignificant 50% reduction in the rer. Of patients less than 70 years of age and 70 years of age and older, 81.3% and 42.0% respectively received guideline-adherent treatment.ConclusionsThis study is the first Quebec population-based examination of patients with lacrc and their management, outcomes, and outcome determinants. The results can help in planning crc control strategies at a population level.