Top

Published in:

Open Access 01-12-2021 | Colorectal Cancer | Research

Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study

Authors: Inge van den Berg, Robert R. J. Coebergh van den Braak, Jeroen L. A. van Vugt, Jan N. M. Ijzermans, Stefan Buettner

Published in: World Journal of Surgical Oncology | Issue 1/2021

Abstract

Background

Colorectal cancer is the third most common type of cancer in the world. We characterize a cohort of patients who survived up to 5 years without recurrence and identify factors predicting the probability of cure.

Methods

We analyzed data of patients who underwent curative intent surgery for stage I–III CRC between 2007 and 2012 and who had had been included in a large multicenter study in the Netherlands. Cure was defined as 5-year survival without recurrence. Survival data were retrieved from a national registry.

Results

Analysis of data of 754 patients revealed a cure rate of 65% (n = 490). Patients with stage I disease and T1- and N0-tumor had the highest probability of cure (94%, 95% and 90%, respectively). Those with a T4-tumor or N2-tumor had the lowest probability of cure (62% and 50%, respectively). A peak in the mortality rate for older patients early in follow-up suggests early excess mortality as an explanation. Patients with stage III disease, poor tumor grade, postoperative complications, sarcopenia and R1 resections show a similar trend for decrease in CSS deaths over time.

Conclusion

In the studied cohort, the probability of cure for patients with stage I–III CRC ranged from 50 to 95%. Even though most patients will be cured from CRC with standard therapy, standard therapy is insufficient for those with poor prognostic factors, such as high T- and N-stage and poor differentiation grade.

The Global Cancer Observatory (GCO). https://gco.iarc.fr/. Accessed Aug 2020.

Dienstmann R, Mason MJ, Sinicrope FA, Phipps AI, Tejpar S, Nesbakken A, et al. Prediction of overall survival in stage II and III colon cancer beyond TNM system: a retrospective, pooled biomarker study. Ann Oncol. 2017;28(5):1023–31. https://doi.org/10.1093/annonc/mdx052.CrossRefPubMedPubMedCentral

Karahalios A, English DR, Simpson JA. Weight change and risk of colorectal cancer: a systematic review and meta-analysis. Am J Epidemiol. 2015;181(11):832–45. https://doi.org/10.1093/aje/kwu357.CrossRefPubMed

Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body fatness and cancer--viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794–8. https://doi.org/10.1056/NEJMsr1606602.CrossRefPubMedPubMedCentral

Yuhara H, Steinmaus C, Cohen SE, Corley DA, Tei Y, Buffler PA. Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol. 2011;106(11):1911–21; quiz 1922. https://doi.org/10.1038/ajg.2011.301.CrossRefPubMedPubMedCentral

Longo WE, Johnson FE. The preoperative assessment and postoperative surveillance of patients with colon and rectal cancer. Surg Clin North Am. 2002;82(5):1091–108. https://doi.org/10.1016/S0039-6109(02)00050-6.CrossRefPubMed

Society AC. Cancer facts & figures 2020. Am Cancer Soc J CA. 2020. p. 3.

Rondeau V, Schaffner E, Corbiere F, Gonzalez JR, Mathoulin-Pelissier S. Cure frailty models for survival data: application to recurrences for breast cancer and to hospital readmissions for colorectal cancer. Stat Methods Med Res. 2013;22(3):243–60. https://doi.org/10.1177/0962280210395521.CrossRefPubMed

Lambert PC, Thompson JR, Weston CL, Dickman PW. Estimating and modeling the cure fraction in population-based cancer survival analysis. Biostatistics. 2007;8(3):576–94. https://doi.org/10.1093/biostatistics/kxl030.CrossRefPubMed

10.

Primrose JN, Perera R, Gray A, Rose P, Fuller A, Corkhill A, et al. Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial. JAMA. 2014;311(3):263–70. https://doi.org/10.1001/jama.2013.285718.CrossRefPubMed

11.

Wille-Jørgensen P, Syk I, Smedh K, Laurberg S, Nielsen DT, Petersen SH, et al. Effect of more vs less frequent follow-up testing on overall and colorectal cancer–specific mortality in patients with stage II or III colorectal cancer: the COLOFOL randomized clinical trial. JAMA. 2018;319(20):2095–103. https://doi.org/10.1001/jama.2018.5623.CrossRefPubMedPubMedCentral

12.

Dutch Cancer Institute. Colorectal cancer guideline. 2017.

13.

Yu Y, Carey M, Pollett W, Green J, Dicks E, Parfrey P, et al. The long-term survival characteristics of a cohort of colorectal cancer patients and baseline variables associated with survival outcomes with or without time-varying effects. BMC Med. 2019;17(1):150. https://doi.org/10.1186/s12916-019-1379-5.CrossRefPubMedPubMedCentral

14.

Bouvier A-M, Launoy G, Bouvier V, Rollot F, Manfredi S, Faivre J, et al. Incidence and patterns of late recurrences in colon cancer patients. Int J Cancer. 2015;137(9):2133–8. https://doi.org/10.1002/ijc.29578.CrossRefPubMed

15.

Lalmahomed ZS, Coebergh van den Braak RRJ, Oomen MHA, Arshad SP, Riegman PHJ, IJzermans JN, et al. Multicenter fresh frozen tissue sampling in colorectal cancer: does the quality meet the standards for state of the art biomarker research? Cell Tissue Bank. 2017;18(3):425–31. https://doi.org/10.1007/s10561-017-9613-x.CrossRefPubMedPubMedCentral

16.

Kloosterman WP, Coebergh van den Braak RRJ, Pieterse M, van Roosmalen MJ, Sieuwerts AM, Stangl C, et al. A systematic analysis of oncogenic gene fusions in primary colon cancer. Cancer Res. 2017;77(14):3814–22. https://doi.org/10.1158/0008-5472.CAN-16-3563.CrossRefPubMed

17.

Creasy JM, Sadot E, Koerkamp BG, Chou JF, Gonen M, Kemeny NE, et al. Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure? Surgery. 2018;163(6):1238–44. https://doi.org/10.1016/j.surg.2018.01.004.CrossRefPubMed

18.

van Vugt JLA, Buettner S, Levolger S, Coebergh van den Braak RRJ, Suker M, Gaspersz MP, et al. Low skeletal muscle mass is associated with increased hospital expenditure in patients undergoing cancer surgery of the alimentary tract. PLoS One. 2017;12(10):e0186547. https://doi.org/10.1371/journal.pone.0186547.CrossRefPubMedPubMedCentral

19.

Othus M, Barlogie B, Leblanc ML, Crowley JJ. Cure models as a useful statistical tool for analyzing survival. Clin Cancer Res. 2012;18(14):3731–6. https://doi.org/10.1158/1078-0432.CCR-11-2859.CrossRefPubMedPubMedCentral

20.

Yilmaz YE, Lawless JF, Andrulis IL, Bull SB. Insights from mixture cure modeling of molecular markers for prognosis in breast cancer. J Clin Oncol. 2013;31(16):2047–54. https://doi.org/10.1200/JCO.2012.46.6615.CrossRefPubMed

21.

Sy JP, Taylor JM. Estimation in a Cox proportional hazards cure model. Biometrics. 2000;56(1):227–36. https://doi.org/10.1111/j.0006-341X.2000.00227.x.CrossRefPubMed

22.

Chao Cai YZ, Peng Y, Zhang J. Fit semiparametric mixture cure models. In: An R-package for estimating semiparametric PH and AFT mixture cure models, vol. 2.0; 2012.

23.

Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol. 2010;28(2):264–71. https://doi.org/10.1200/JCO.2009.24.0952.CrossRefPubMed

24.

Blenkinsopp WK, Stewart-Brown S, Blesovsky L, Kearney G, Fielding LP. Histopathology reporting in large bowel cancer. J Clin Pathol. 1981;34(5):509–13. https://doi.org/10.1136/jcp.34.5.509.CrossRefPubMedPubMedCentral

25.

Schneider NI, Langner C. Prognostic stratification of colorectal cancer patients: current perspectives. Cancer Manag Res. 2014;6:291–300. https://doi.org/10.2147/CMAR.S38827.CrossRefPubMedPubMedCentral

26.

Serrano Del Moral A, Perez Viejo E, Manzanedo Romero I, Rodriguez Caravaca G, Pereira Perez F. Systematic second-look surgery plus HIPEC in patients without evidence of recurrence, at high risk of carcinomatosis after colorectal cancer resection. Cir Esp. 2018;96(2):96–101. https://doi.org/10.1016/j.ciresp.2017.11.006.CrossRefPubMed

27.

Elias D, Honoré C, Dumont F, Ducreux M, Boige V, Malka D, et al. Results of systematic second-look surgery plus hipec in asymptomatic patients presenting a high risk of developing colorectal peritoneal carcinomatosis. Ann Surg. 2011;254(2):289–93. https://doi.org/10.1097/SLA.0b013e31822638f6.CrossRefPubMed

28.

Sammartino P, Sibio S, Biacchi D, Cardi M, Mingazzini P, Rosati MS, et al. Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases. Int J Colorectal Dis. 2014;29(9):1081–9. https://doi.org/10.1007/s00384-014-1929-4.CrossRefPubMed

29.

Moran BJ. PROPHYLOCHIP: no benefit of second-look surgery plus HIPEC for colorectal peritoneal metastases. Lancet Oncol. 2020;21(9):1124–5. https://doi.org/10.1016/S1470-2045(20)30338-7.CrossRefPubMed

30.

Klaver CEL, Wisselink DD, Punt CJA, Snaebjornsson P, Crezee J, Aalbers A, et al. Adjuvant HIPEC in patients with colon cancer at high risk of peritoneal metastases: Primary outcome of the COLOPEC multicenter randomized trial. J Clin Oncol. 2019;37:482.

31.

Baghestani AR, Daneshva T, Pourhoseingholi MA, Asadzadeh H. Survival of colorectal cancer in the presence of competing- risks - modeling by Weibull Distribution. Asian Pac J Cancer Prev. 2016;17(3):1193–6. https://doi.org/10.7314/APJCP.2016.17.3.1193.CrossRefPubMed

32.

Morrison DS, Parr CL, Lam TH, Ueshima H, Kim HC, Jee SH, et al. Behavioural and metabolic risk factors for mortality from colon and rectum cancer: analysis of data from the Asia-Pacific Cohort Studies Collaboration. Asian Pac J Cancer Prev. 2013;14(2):1083–7. https://doi.org/10.7314/APJCP.2013.14.2.1083.CrossRefPubMed

33.

Cree M, Tonita J, Turner D, Nugent Z, Alvi R, Barss R, et al. Comparison of treatment received versus long-standing guidelines for stage III colon and stage II/III rectal cancer patients diagnosed in Alberta, Saskatchewan, and Manitoba in 2004. Clin Colorectal Cancer. 2009;8(3):141–5. https://doi.org/10.3816/CCC.2009.n.023.CrossRefPubMed

34.

Winget M, Hossain S, Yasui Y, Scarfe A. Characteristics of patients with stage III colon adenocarcinoma who fail to receive guideline-recommended treatment. Cancer. 2010;116(20):4849–56. https://doi.org/10.1002/cncr.25250.CrossRefPubMed

35.

Lemmens VE, van Halteren AH, Janssen-Heijnen ML, Vreugdenhil G, Repelaer van Driel OJ, Coebergh JW. Adjuvant treatment for elderly patients with stage III colon cancer in the southern Netherlands is affected by socioeconomic status, gender, and comorbidity. Ann Oncol. 2005;16(5):767–72. https://doi.org/10.1093/annonc/mdi159.CrossRefPubMed

36.

Quipourt V, Jooste V, Cottet V, Faivre J, Bouvier AM. Comorbidities alone do not explain the undertreatment of colorectal cancer in older adults: a French population-based study. J Am Geriatr Soc. 2011;59(4):694–8. https://doi.org/10.1111/j.1532-5415.2011.03334.x.CrossRefPubMed

37.

van Erning FN, van Steenbergen LN, Lemmens V, Rutten HJT, Martijn H, van Spronsen DJ, et al. Conditional survival for long-term colorectal cancer survivors in the Netherlands: who do best? Eur J Cancer. 2014;50(10):1731–9. https://doi.org/10.1016/j.ejca.2014.04.009.CrossRefPubMed

38.

Azizmohammad Looha M, Pourhoseingholi MA, Nasserinejad M, Najafimehr H, Zali MR. Application of a non-parametric non-mixture cure rate model for analyzing the survival of patients with colorectal cancer in Iran. Epidemiol Health. 2018;40:e2018045. https://doi.org/10.4178/epih.e2018045.CrossRefPubMedPubMedCentral

39.

Paulson EC, Wirtalla C, Armstrong K, Mahmoud NN. Gender influences treatment and survival in colorectal cancer surgery. Dis Colon Rectum. 2009;52(12):1982–91. https://doi.org/10.1007/DCR.0b013e3181beb42a.CrossRefPubMed

40.

McArdle CS, McMillan DC, Hole DJ. Male gender adversely affects survival following surgery for colorectal cancer. Br J Surg. 2003;90(6):711–5. https://doi.org/10.1002/bjs.4098.CrossRefPubMed

41.

Majek O, Gondos A, Jansen L, Emrich K, Holleczek B, Katalinic A, et al. Sex differences in colorectal cancer survival: population-based analysis of 164,996 colorectal cancer patients in Germany. PLoS One. 2013;8(7):e68077. https://doi.org/10.1371/journal.pone.0068077.CrossRefPubMedPubMedCentral

42.

Micheli A, Ciampichini R, Oberaigner W, Ciccolallo L, de Vries E, Izarzugaza I, et al. The advantage of women in cancer survival: an analysis of EUROCARE-4 data. Eur J Cancer. 2009;45(6):1017–27. https://doi.org/10.1016/j.ejca.2008.11.008.CrossRefPubMed

43.

van Eeghen EE, Bakker SD, van Bochove A, Loffeld RJ. Impact of age and comorbidity on survival in colorectal cancer. J Gastrointest Oncol. 2015;6(6):605–12. https://doi.org/10.3978/j.issn.2078-6891.2015.070.CrossRefPubMedPubMedCentral

44.

Pule ML, Buckley E, Niyonsenga T, Roder D. The effects of comorbidity on colorectal cancer mortality in an Australian cancer population. Sci Rep. 2019;9(1):8580. https://doi.org/10.1038/s41598-019-44969-8.CrossRefPubMedPubMedCentral

45.

Guinney J, Dienstmann R, Wang X, de Reynies A, Schlicker A, Soneson C, et al. The consensus molecular subtypes of colorectal cancer. Nat Med. 2015;21(11):1350–6. https://doi.org/10.1038/nm.3967.CrossRefPubMedPubMedCentral

Title: Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study
Authors: Inge van den Berg
Robert R. J. Coebergh van den Braak
Jeroen L. A. van Vugt
Jan N. M. Ijzermans
Stefan Buettner
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2021
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-021-02207-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Letter to the Editor concerning the article “Clinical outcomes of chondroblastoma treated using synthetic bone substitute: risk factors for developing radiographic joint degeneration”

Oncological outcomes of laparoscopic versus open nephroureterectomy for the treatment of upper tract urothelial carcinoma: an updated meta-analysis

Intercalary prosthetic replacement is a reliable solution for metastatic humeral shaft fractures: retrospective, observational study of a single center series

The prognostic value of arginase-1 and glypican-3 expression levels in patients after surgical intrahepatic cholangiocarcinoma resection

Is three-dimensional–printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect?

Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection