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

1
Prognosis of colon cancer compared with rectal
cancer. Where lies the difference?

• Bjørn S. Nedrebø
• Stavanger University Hospital

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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

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Colorectal Cancer in Norway Evolution of
Treatment Recommendations
Rectal Cancer
National Registry Introduction TME
Rx T4, fixed
MRI staging CRM 3 mm MDT
1993/94
2000
1997
2003
Cx Stage III 75 yrs
Colon Cancer
3
4
Patient Cohort
Norwegian Cancer Registry Rectal Cancer
Registry, 1994 2003
N31158 (100)
Metachronous cancer n1486 (5)
N29672( 95)
Metastases n9024 (29)
N20648 (66)
Minor resections N1595 (5)
Study population N19053 (61)
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Method

• 5 year relative survival for all patients
• Excess mortality in different timeperiods
• Time periods
• (1) 1994-1996 (N5400) (2) 2001-2003 (N5870)
• 70 Colon cancer in both periods

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Analysis

• Localisation
• Rectum ( 15 cm from anal verge)
• Colon
• Stage
• N0 (T1-4, N0)
• N (T1-4, N1-2)
• Age lt75 vs. 75 year

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Patient Characteristics
Period 1 Period 2 P
Sex (males, ) 48 49 n.s
Age gt 75 yrs 37 42 lt0.001
Stage N0 N 68 32 62 38 lt0.001
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Improved survivalColon and rectal cancer
1994-1996
2001-2003
Colon
Rektum
plt0.01
plt0.01
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Fig 1 a-b Early studyperiod vs late studyperiod
1a Colon cancer
1b Rectal cancer

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Colon vs rectum
Colon
Rectum
Early period
Late period
plt0.03
plt0.74
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Fig 2 a-b. Coloncancer vs rectumcancer
2b Late period
2a Early period
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Colon early vs late
1994-1996
2001-2003
N
N0
13
Rectal cancer, early vs late
1994-1996
2001-2003
N0
N
14
N
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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

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Age
Age N 12 lymph nodes
lt65 26 74
65-69 13 74
70-74 15 66
75-79 17 66
80-84 16 65
gt85 13 66
17
Sex/localisation
Sex N 12 lymph nodes
Male 47 67
Female 53 70
Right colon 56 74
Left colon 44 63

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Hospital volume
Hospital volume / year N 12 lymph nodes
gt60 59 71
40-59 26 69
20-39 5 58
10-20 7 66
lt10 3 60
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Elective vs acute
N 12 lymph nodes
Elective 84 72
Acute w/ obstruction 11 64
Acute w/ perforation lt1 64


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Multivariatanalyse

• 12 lymph nodes
• Pasient lt70 years
• Elective surgery
• High volume hospital
• pT gt1
• Right sided resection
• Pathological template

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Conclusion

• Better survival for rectal cancer than colon
  cancer
• Need to focus on colon cancer, especially
• patients over 75 years
• acute surgery
• high volume hospitals(?)
• standardised pathology template