The utility of tumor marker combination,including serum P53 antibody,in colorectal cancer treatment

Purposes

Serum P53 antibody (S-P53Ab) is reportedly an effective screening tool for cancer. The aim of this study is to investigate the clinical significance of tumor markers combination in colorectal cancer (CRC) patients.

Methods

Carcinoembryonic antigen (CEA), carbohydrate 19?-?9 (CA19-9), and S-P53Ab levels were measured before tumor resection. Of the CRC patients with primary tumor resection at Kumamoto University Hospital, a total of 244 with available preoperative data for these three tumor markers were eligible for this study. The associations of the tumor markers with clinicopathological factors and the prognosis were examined using univariate and multivariate analyses.

Results

S-P53Ab positivity was strongly correlated with rectal cancer, depth of tumor invasion, lymph node metastasis, and lymphatic invasion. The ratio of S-P53Ab positivity was higher than that of CEA or CA19-9 in patients with stage 0/I disease. S-P53Ab had no power to predict the prognosis (P?=?0.786). The patients with combined CEA and CA19-9 positivity had a significantly poorer overall survival than those with positivity for neither or only one, and combined CEA and CA19-9 positivity was an exclusive independent prognostic factor (P?=?0.034).

Conclusions

The clinical significance of S-P53Ab measurement in CRC patients is limited. However, the combination of CEA and CA19-9 levels may be effective for predicting the outcomes of CRC treatment.

     

Clinicopathological characteristics and long-term outcomes of colorectal cancer in elderly Chinese patients undergoing potentially curative surgery

Purpose

The aim of this study was to determine the clinicopathological characteristics and outcomes of Chinese colorectal cancer (CRC) patients aged 75 years and older undergoing potentially curative surgery.

Methods

A total of 2,482 CRC patients at TNM stage I–III undergoing surgical treatment between 1995 and 2005 were evaluated, and patients were divided into a younger (<75 years old) and an elderly (≥75 years) group.

Results

There were 2,482 CRC patients in this study, of which 2,194 (88.4 %) patients were in the younger group (mean age 57 years) and 288 (11.6 %) were in the elderly group (mean age 79 years). Significant differences were observed between the two groups with regard to the American Society of Anesthesiologists’ score, tumor location, co-morbidities, emergency procedures, use of chemotherapy, proportion admitted to the ICU, length of ICU stay, causes of death, T/N stage and postoperative recurrence. The postoperative mortality increased from 4.8 % in the younger group to 8.3 % in the older group (p = 0.011). Although significant differences were found in the overall 5-year survival (73 vs. 56 %, p < 0.0001) and disease-free 5-year survival (68 vs. 54 %, p < 0.0001) between the two groups, the cancer-specific 5-year survival was similar (88 vs. 85 %, p = 0.089) in both groups.

Conclusions

Although elderly CRC patients have unique clinicopathological features, a higher postoperative mortality and a worse overall and disease-free survival compared with younger patients, the cancer-specific survival at five years is similar between elderly and younger patients. Elderly patients benefit from radical surgery and have a good postoperative oncological outcome, irrespective of their age.     

Characteristics of colorectal cancer in young patients at an urban county hospital

Colorectal cancer (CRC) is a disease primarily affecting an older population. The incidence of CRC in young patients has been rising. The purpose of this study was to evaluate the characteristics of CRC in an ethnically diverse, young population. Two groups of patients with CRC (40 years old or younger and 60 years old or older) treated from 1998 to 2005 were retrospectively evaluated. Forty-one young patients with CRC were identified. Hispanics constituted 51 per cent of the young population. Forty-four per cent of the lesions were right-sided in the young group compared with 21 per cent in the older group (P = 0.004). Advanced tumor stage (T3 and T4) was noted in 87.8 per cent of the young and 63 per cent of the older patients (P = 0.002; OR, 4.08). Poorly differentiated tumor grade was more common in young patients (P = 0.003) as well as mucinous/ signet ring characteristics (P = 0.005). Young patients had an increased likelihood of a family history (P = 0.0001). Operative intervention and survival were similar for the two groups. Our study confirms, in an ethnically diverse young population, that CRC tends to be advanced stage, aggressive, and frequently nonoperable at the time of diagnosis. It is important for physicians to recognize the poor outcome of CRC in a younger population and consider an aggressive approach to diagnosis and early treatment.     

Changing trends in age and stage of colorectal cancer presentation in Ireland – From the nineties to noughties and beyond

Background

Recent studies report incidence of colorectal (CRC) in younger adults (<50 years old) is increasing, and these patients are more likely to present with advanced disease. We performed a population-based analysis of these trends in an Irish population.

Influence of Young Age on Outcome After Esophagectomy for Cancer

Background

The incidence of esophageal cancer has risen among all age groups. Controversy exists about the clinical presentation and prognosis of young patients. The aim of this study was to compare the clinicopathologic characteristics and outcomes after surgery between patients with esophageal cancer who were <50?years of age and those ≥50?years of age.

Methods

Patients diagnosed with esophageal carcinoma who underwent esophagectomy between January 1990 and December 2010 in a single institution were selected from a prospective database. Patients aged <50?years at diagnosis (n?=?163) were compared with those ≥50?years (n?=?1151) with respect to clinicopathologic stage and oncologic outcome.

Results

Younger patients had less co-morbidity (p?<?0.001). There were no significantly differences in tumor localization, histology, differentiation, or TNM stage in the two groups. In both groups, 37?% of the patients underwent neoadjuvant chemo(radio)therapy. One or more nonsurgical complications developed in 53?% of the older group versus 42?% in the younger group (p?=?0.012). In-hospital mortality was 6.3?% for patients ≥50?years compared to 1.8?% for younger patients (p?=?0.021). The 5?year overall survival was significantly better for the younger patients than for those ≥50?years (41 vs. 31?%, p?<?0.001), but median disease-specific and disease-free survival did not differ between the groups (37 vs. 30?months, p?=?0.140 and 49 vs. 28?months, p?=?0.079, respectively). Multivariate analysis identified moderate, poorly, and undifferentiated tumors; tumor-positive resection margins (pR1–2); and TNM stage IIB–IV as independent predictors of disease-specific survival.

Conclusions

A considerable proportion (12?%) of patients diagnosed with resectable esophageal carcinoma were <50?years. Phenotypic tumor characteristics and disease-specific survival were comparable for the two age groups.     

Differences in clinicopathological characteristics of colorectal cancer between younger and elderly patients: an analysis of 322 patients from a single institution

Background

The prognosis of patients with colorectal cancer (CRC) of different onset ages is controversial.

Methods

Data were obtained from a prospective database at Taipei Veterans General Hospital. There were 2,738 newly diagnosed patients with CRC from 2001 to 2006. Two extreme age groups, younger (≤40 years) and elderly (≥80 years), were analyzed to compare clinicopathologic characteristics and prognosis after exclusion of specific cancer syndrome.

Results

A total of 322 patients were enrolled in this prospective study. The younger group consisted of 69 patients with mean age of 33.5 years, and the elderly group consisted of 253 patients with mean age of 83.4 years. Younger patients had a higher incidence of mucinous cell type (14.5% vs 6.3%, P = .05), poorly differentiated adenocarcinoma (26.1% vs 6.3%, P < .001), more advanced disease (82.6% vs 41.9%, P < .001), poorer disease-free survival (67.2% vs 79.3%, P = .048), and cancer-specific survival (44.1% vs 73.1%, P < .001) than elderly patients.

Conclusions

In patients with CRC of younger onset, without relevant predisposing risk factors, younger patients have more advanced stages of disease, more aggressive histopathologic characteristics, and poorer prognoses compared with older patients.     

Adenocarcinoma of the Esophagus in the Young

Introduction

Practitioners have noted a striking increase in the number of young patients under the age of 40 years old who develop esophageal adenocarcinoma. The aim of this study was to characterize the presentation, pathology and therapeutic outcome of these young patients.

Methods

The records of patients who presented to the Foregut Surgical Service at the University of Southern California with esophageal adenocarcinoma between 2000 and 2007 were retrospectively reviewed. The presentation, tumor stage and histology, therapy and outcome of the patients under the age of 40 were compared to those ≥40.

Results

Of the 374 patients reviewed, 20 (5 %) were under the age of 40. There were two patients in their second and 18 in their third decade of life. The youngest patient was 25 years old. A history of gastroesophageal reflux disease or Barrett’s esophagus was less common in patients <40 than in those ≥40; 15 and 5 % compared to 61 and 46 %. Similarly, patients <40 had a significantly longer time interval between the onset of symptoms and the diagnosis of their cancer than those ≥40; 4.5 vs. 2 months, p?=?0.04. They also had a higher prevalence of stage IV disease (30 vs. 6 %, p?=?0.0003), a shorter time to recurrence (9.5 vs.19 month, p?=?0.002), and a poorer median survival (17 vs. 43 month, p?=?0.04).

Conclusion

Esophageal adenocarcinoma in patients <40 years old commonly presents with an advanced stage of the disease and an associated poor survival. This is likely due to a low index of suspicion that dysphagia seen in younger patients is due to a malignancy.     

Molecular Detection of APC,K-ras,and p53 Mutations in the Serum of Colorectal Cancer Patients as Circulating Biomarkers

Early detection of tumor DNA in serum/plasma prior to the development of recurrence or metastases could help improve the outcome of patients with colorectal cancer (CRC) after tumor resection. Recent advances in the detection of tumor DNA in the serum/plasma has opened up numerous new areas for investigation and new possibilities for molecular diagnosis. APC and K-ras mutations are considered to be early-stage developments of CRCs, whereas p53 mutations are thought to be relatively late events in the tumorigenesis of CRCs. The aim of this study was to search for the presence of genetic mutations in the DNA extracted from the serum of CRC patients and healthy subjects. We simultaneously evaluate the significance of APC, K-ras, and p53 gene mutations in cancer tissues and their paired serum samples of 104 CRC patients by polymerase chain reaction-single strand conformation polymorphism analysis (PCR-SSCP) followed by direct sequencing. Additionally, analysis was carried out to detect the serum carcinoembryonic antigen (CEA) levels in CRC patients. Overall, we found at least one of the gene mutations in tumor tissues from 75% (78/104) of the CRC patients. Comparison of the three molecular markers showed that the detection rates in the serum were 30.4%, 34.0%, and 34.2% for APC, K-ras, and p53 genes, respectively. Of these patients, 46.2% (36/78) were identified as having positive serum results, whereas all healthy controls remained negative. The overall positive tumor DNA detection rates in the serum were 0% (0/7) for Dukes A classification, 22.4% (11/49) for Dukes B, 48.7% (19/39) for Dukes C, and 66.7% (6/9) for Dukes D. The detection rate increased as the tumor stage progressed (p = 0.012). Concurrently, a significant difference was observed between lymph node metastases and positive serum tumor DNA detection (p < 0.001). A significantly higher postoperative metastasis/recurrence rate in patients harboring gene mutations with serum tumor DNA than those without serum tumor DNA was also demonstrated (p < 0.001). However, no significant correlation between the postoperative metastasis/recurrence and serum CEA levels was observed (p = 0.247). These data suggest that the identification of circulating tumor DNA using the molecular detection of APC, K-ras, and p53 gene mutations is a potential tool for early detection of postoperative recurrence/metastases. Moreover, these genes may be potential molecular markers of poor clinical outcome in CRC patients.     

Low Nutritional Prognostic Index Correlates with Poor Survival in Patients with Stage IV Colorectal Cancer Following Palliative Resection of the Primary Tumor

Background

We retrospectively investigated the prognostic significance of various clinicopathological factors and preoperative nutritional status to select patients with stage IV colorectal cancer (CRC) who will have a poor prognosis after palliative resection of the primary tumor.

Methods

A total of 100 stage IV CRC patients who underwent palliative resection were enrolled. Various clinicopathological factors and Onodera’s prognostic nutritional index (OPNI) were evaluated to identify any possible relationship with the prognosis.

Results

At the time of the analysis, 83 patients had died, and the median survival time was 21 months. Of the 100 patients, 24 had primary tumor-related symptoms such as obstruction or bleeding. No significant correlation was noted between the OPNI and various clinicopathological factors. The multivariate analysis of patients without primary tumor-related symptoms revealed that the OPNI was an independent prognostic factor. The overall survival of the low-OPNI group was significantly worse than that of the high-OPNI group.

Conclusions

This retrospective study suggested that patients with a low OPNI may not be candidates for palliative resection, because it provides no survival benefit to these patients.     

Lynch syndrome in a predominantly Afrocentric population: a clinicopathological and genetic study

Background

We investigated the prevalence of Lynch syndrome as a hereditary cause of colon cancer in the young Jamaican colorectal cancer (CRC) population.

Methods

We identified patients aged 40 years or younger in whom primary CRC was diagnosed at the University Hospital of the West Indies from January 2004 to December 2008. We reviewed the medical records and hematoxylin and eosin (H&E)–stained histopathology slides. Tumour blocks were tested for microsatellite instability (MSI). Patients with MSI–high phenotype (MSI-H) tumours had genetic counselling, after which genomic DNA was extracted from peripheral blood to test for MLH1 and MSH2 germline mutations. Patients also had pedigree mapping.

Results

There were 25 patients with CRC aged 40 years or younger with no history of hereditary colon cancer syndrome. The patients’ mean age was 33 (range 21–40) years. Histopathologic review confirmed CRC in all patients; 8 of 25 (32%) showed morphologic features suggestive of MSI. We detected MSI-H in 5 of 23 (22%) tumour blocks tested. Review with H&E staining correctly identified 80% of cases positive for MSI-H. The false-positive rate and positive predictive value on H&E review was 50%. The negative predictive value of histomorphologic H&E review was 94%. Three patients were available for and had mutational analysis of DNA mismatch repair genes; 2 were positive for mutations in keeping with Lynch syndrome and 1 had MLH1 alterations of uncertain significance. All 3 met the Amsterdam criteria for hereditary nonpolyposis CRC.

Conclusion

Thirteen percent of the population had mutations in keeping with Lynch syndrome. This prevalence is similar to that reported for white populations.     

Elevated Levels of Apoptosis Regulator Proteins P53 and BCL-2 are Independent Prognostic Biomarkers in Surgically Treated Clinically Localized Prostate Cancer

Purpose

The tumor suppressor gene (TSG) p53 and the proto-oncogene bcl-2 have been shown to be involved in the regulation of cell growth and apoptosis and have been implicated in hormone refractory prostate cancer (PC) and poor prognosis. The goal of this study was to determine the clinical utility of the presence of p53 and bcl-2 immunohistochemical (IHC) protein in the primary tumor as predictors of disease progression following radical prostatectomy (RP).

Materials and Methods

The expression of p53 and bcl-2 was evaluated in archival paraffin-embedded RP specimens from 175 patients followed from 1 to 9 years (mean = 4.6 years) and correlated with stage, grade, race and serologic (PSA) recurrence following surgery.

Results

Overexpression of bcl-2 was noted in 47 of 175 (26.9 percent) patients; these patients had a significantly higher 5-year failure rate than those who did not overexpress bcl-2 (67.0 percent versus 30.7 percent). Expression of p53 was noted in 114 of 175 (65.1 percent) patients with a 5-year failure rate of 51.1 percent compared with a 5-year failure rate of only 22 percent in p53 negative patients. When expression rates for p53 and bcl-2 were combined, the 5-year failure rate was 75.3 percent. Conversely, when both p53 and bcl-2 IHC staining were negative, the 5-year failure rate was 20.4 percent. Univariate Kaplan-Meier analysis showed a statistically significant difference between p53 and bcl-2 positive and negative patients (p less than 0.001). Multivariate Cox Regression Analysis with backward elimination controlling for age, race, stage and grade showed both p53 (p = .0185) and bcl-2 (p = .044) to be independent predictors of disease-free survival.

Conclusion

p53 and bcl-2 appear to be important biomarkers that predict recurrence in clinically localized PC after RP.     

青年人胃癌

目的 探讨40岁以下青年人胃癌的临床病理特征。方法 回顾性分析了10年间收治的304例41岁以下青年人胃癌病例,结果 40岁以下病例占同期全部病例的4.9%,其中36岁以下患占2.4%,病理分类中以弥漫型癌多见,占196例,肠型胃癌98例;肿瘤的TNM分期中Ⅳ期病例占53.95%,进展期病变占全部的83.2%;手术切除率为73.9%,根治手术率为56.0%,全组5、10年总生存率分别为28.7%和24.9%,多因素回归分析表明远处转移,肿瘤病理分期以及肿瘤的根治度是影响预手的独立因素,结论 青年人病例类型以弥漫型癌占多数,进展期病变占绝大多数,手术切除率较低,年龄不是影响预后的独立因素。但是30岁以下患预后不良。     

The impact of age on outcome after surgery for colorectal adenocarcinoma

INTRODUCTION

The incidence of colorectal cancer (CRC) increases with age. The aim of this study was to investigate the impact of age and age-related factors on post-operative mortality and survival following CRC resections.

METHODS

A prospectively collected database of 459 CRC resections was analysed.

RESULTS

The mean age of the patients was 70 years (range: 25–95 years) and 54% were male. The relative proportion of female patients increased with age so that for patients aged over 77 more women were treated than men. The probability of undergoing an emergency resection (25%) did not change with age. In older patients the proportion of rectal cancers resected decreased and the proportion of hemicolectomies and Hartmann''s operations performed increased. The 30-day mortality rate was 4% after elective and 11% after emergency resections. Most deaths were caused by medical complications, reflecting increased co-morbidity in the elderly. Post-operative mortality was 1% in patients under the age of 59. This increased by 3 percentage points every 10 years after elective resections and by 8 percentage points every 10 years after emergency resections. CRC-specific survival was independent of age whereas overall survival decreased so the likelihood of dying from CRC decreased with age: at age 50 half the deaths were from CRC, at age 70 a third and at age 80 a quarter.

CONCLUSIONS

CRC stage and the probability of presenting as an emergency did not change with age but older patients were more likely to be female and have colon cancer. Post-operative mortality progressively increased with age. Most deaths were caused by medical complications, reflecting increased co-morbidity. Older patients were less likely to die from CRC.     

Immunohistochemical analysis of K-RAS expression in curatively treated colorectal cancer patients: Correlations of clinicopathological features with clinical outcome

Aim-Background

The study was conducted to assess the relationship between the presence of K-RAS oncogene expression in samples of colorectal carcinomas (CRC) and the clinicopathological data of investigated patients.

Methods

One hundred patients (55 females/mean age 64.55 years) with curable CRC treated during period 1/1/2000–31/12/2006 were studied. Eligibility criteria for cases included diagnosis with first primary incident CRC, age up to 75 years, and mental competence. Patients with distant metastasis, severe concomitant disease, coexistent malignancy, ulcerative colitis or Crohn’s disease, familial adenomatous polyposis, or immediate severe complication or death were excluded. The tumours concerned adenocarcinomas at TNM stages 0-I (26 patients), II (46 patients), and III (28 patients). Eighty-seven patients received chemotherapy, chemoradiotherapy or radiotherapy. All tumour specimens were reviewed for immunohistochemistry. Expressions of K-RAS and secondarily P53 were identified, and intensity/distribution was evaluated. All clinicopathological parameters were recorded. The cross-tabulation technique was used for variance analysis. P-values ≤0.05 were considered statistically significant.

Results

At 5-year-follow-up, 11 deaths had occurred (stages II:4, III:7) among 20 recurrences (N1:8, N2:2). Deaths were associated with moderate (3 patients), moderate-intense (2 patients) and intense (6 patients) K-RAS staining (p=0.008), and with invasiveness of the tumour (p=0.0089), lymphnode metastasis (p<0.0001) and worse tumour differentiation (p<0.0001). A statistical significance was revealed among the general population between K-RAS intense staining and both worse tumour differentiation (p=0.0066) and N1 lymph-node metastasis (p=0.0469). A statistical significance between K-RAS and P53 expressions in women with T3 tumours was also noted (p=0.0387).

Conclusions

K-RAS overexpression correlated well with worse differentiation, lymph-node metastasis and invasive histologic mode in CRC.     

APC, K-ras, and p53 gene mutations in colorectal cancer patients: correlation to clinicopathologic features and postoperative surveillance

Current researches have proposed a genetic model for colorectal cancer (CRC), in which the sequential accumulation of mutations in specific cancer-related genes, including adenomatous polyposis coli (APC), K-ras, and p53, drives the transition from normal epithelium through increasing adenomatous dysplasia to colorectal cancer. To identify patients with an increased risk of tumor recurrence or metastasis and evaluate the prognostic values of APC, K-ras, and p53 gene mutations, we investigated the frequency of these three mutated genes in tumors and sera of CRC patients. APC, K-ras, and p53 gene mutations in primary tumor tissues and their paired preoperative serum samples of 118 CRC patients were detected by using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis, followed by direct DNA sequencing of the PCR-amplified genomic DNA. Subsequently, serum molecular markers were analyzed for their correlation with patients' clinicopathologic features and presence of postoperative recurrence/metastasis. We did not observe any significant difference in the association of APC or K-ras or p53 gene mutations in primary tumors with patients' demographic data (all were P > 0.05). In contrast, both serum APC and p53 molecular markers were closely correlated with lymph node metastasis and TNM stage (both P < 0.05). Moreover, the serum overall molecular markers (at least one of the three markers) were prominently associated with depth of tumor invasion (P = 0.033), lymph node metastasis (P < 0.001), and TNM stage (P < 0.001). In addition, a significantly higher postoperative metastasis/recurrence rate in patients positive for overall molecular markers compared to those negative for these molecular markers were also demonstrated (P < 0.001). APC and K-ras molecular markers were more frequently observed in patients with locoregional metastasis (both P < 0.05), while p53 molecular marker was usually detected in the cases of peritoneal metastasis (P = 0.004). Our findings suggest that serum molecular markers are potentially useful in the determination of colorectal cancer patients harboring gene mutations at high risk of metastasis. Serial analysis is warranted in order to assess their long-term prognostic significance and the therapeutic implications.     

Colorectal cancer in patients under the age of 40 years: experience from a tertiary care centre in the Czech Republic

Introduction: Colorectal cancer (CRC) in young patients is not an uncommon disease. Reports on its behaviour in young patients are conflicting. The aim of this study was to investigate patient and tumour characteristics, treatment and prognosis of this disease.

Methods: Our study group comprised all patients under the age of 40 years treated with CRC at the Department of Surgery at Motol University Hospital in Prague between the years 2005 and 2015.

Results: Thirty-eight patients under 40 years of age diagnosed with CRC were included in the study. Five patients had Lynch syndrome and six had first-degree relatives with CRC. There were 22 rectal tumours. All but four patients underwent resection of the primary tumour, all patients received chemotherapy and 13 patients received biological therapy. Disease recurrence occurred in 25.8%. Five-year survival was 47.9%. Advanced disease and adverse histological subtypes were identified as poor prognostic factors.

Conclusions: Colorectal cancer in young patients has a high incidence of predisposing conditions, aggressive histological features and advanced disease. Young patients are of a good state of health and thus should receive aggressive therapy. Clinicians should pay more attention to symptoms of CRC in young patients to be able to initiate early treatment.     

Treatment and Outcome of Synchronous Colorectal Carcinomas: A Nationwide Study

Background

Synchronous colorectal carcinomas (CRC) occur in 1–8% of patients diagnosed with CRC. This study evaluated treatment patterns and patient outcomes in synchronous CRCs compared with solitary CRC patients.

Methods

All patients diagnosed with primary CRC between 2008 and 2013, who underwent elective surgery, were selected from the Netherlands Cancer Registry. Using multivariable regressions, the effects of synchronous CRC were assessed for both short-term outcomes (prolonged postoperative hospital admission, anastomotic leakage, postoperative 30-day mortality, administration of neoadjuvant or adjuvant treatment), and 5-year relative survival (RS).

Results

Of 41,060 CRC patients, 1969 patients (5%) had synchronous CRC. Patients with synchronous CRC were older (mean age 71 ± 10.6 vs. 69 ± 11.4 years), more often male (61 vs. 54%), and diagnosed with more advanced tumour stage (stage III–IV 54 vs. 49%) compared with solitary CRC (all p < 0.0001). In 50% of the synchronous CRCs, an extended surgery was conducted (n = 934). Synchronous CRCs with at least one stage II–III rectal tumour less likely received neoadjuvant (chemo)radiation [78 vs. 86%; adjusted OR 0.6 (0.48–0.84)], and synchronous CRCs with at least one stage III colon tumour less likely received adjuvant chemotherapy [49 vs. 63%; adjusted OR 0.7 (0.55–0.89)]. Synchronous CRCs were independently associated with decreased survival [RS 77 vs. 71%; adjusted RER 1.1 (1.01–1.23)].

Conclusions

The incidence of synchronous CRCs in the Dutch population is 5%. Synchronous CRCs were associated with decreased survival compared with solitary CRC. The results emphasize the importance of identifying synchronous tumours, preferably before surgery to provide optimal treatment.

     

What Factors Influence 10-year Survival After Curative Resection of a Colorectal Carcinoma?

Background

Ten-year survival rates are only rarely reported and frequently include a large proportion of censored data—that is, most of the patients have not survived the 10 years. We therefore selected patients in a prospectively maintained, hospital-based tumor register who had been operated on for colorectal carcinoma (CRC) more than 10 years earlier and who were classified as long-term survivors.

Methods

For 589 consecutive CRC patients who underwent R0 resection in the period 1990–1998, we compared prognosis-relevant characteristics and calculated the survival rate as a function of age, sex, location of the tumor, general state of health, urgency of the operation, and pT and pN class. All patients were observed until their death or until at least 10 years after resection. Patients who died of other causes were censored. Overall survival and relative survival (the latter based on tumor-related death) were assessed.

Results

The 10-year survivors were more often female (not significant), younger (p < 0.001), in good general health (p < 0.001), had undergone elective resection (p < 0.001), and had early-stage tumors (p < 0.001). In the univariate analysis emergency operation, impaired general health, invasion beyond the muscularis propria, and lymph-node metastasis were found to reduce relative survival. In the multivariate analysis, location, emergency resection, pT, and pN were found to be statistically independent risk factors.

Conclusions

Long-term freedom from tumor recurrence, like-short-term, is influenced largely by factors that are beneficially influenced by early recognition. The patient’s age at resection is immaterial.     

Major Reduction in 30-Day Mortality After Elective Colorectal Cancer Surgery: A Nationwide Population-Based Study in Denmark 2001–2011

Background

For years, the outcome of colorectal cancer (CRC) surgery has been inferior in Denmark compared to its neighbouring countries. Several strategies have been initiated in Denmark to improve CRC prognosis. We studied whether there has been any effect on postoperative mortality based on the information from a national database.

Methods

Patients who underwent elective major surgery for CRC in the period 2001–2011 were identified in the national Danish Colorectal Cancer Group database. Thirty-day mortality rates were calculated and factors with impact on mortality were identified using logistic regression analysis.

Results

In total, 27,563 patients underwent elective major surgery and their 30-day mortality rate decreased significantly from 7.3 % in 2001–2002 to 2.8 % in 2011 (P < 0.001). Aside from the year of surgery, independent risk factors of mortality were male gender, age ≥61 years, American Society of Anesthesiologists score ≥ II, tumor located in the colon, palliative intent, outcome of surgery “not cured,” and open surgical approach. Additionally, 3-month mortality of all 37,022 CRC patients, irrespective of surgical treatment, decreased significantly from 15.8 to 11.3 % during the study period.

Conclusion

The 30-day mortality rate after elective major surgery for CRC has decreased significantly in Denmark in the past decade. Laparoscopic surgical approach was associated with a reduction in mortality in colon cancer.