Skip to main content

Advertisement

SpringerLink
Log in

Baseline mortality-adjusted survival in colon cancer patients

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

This investigation assessed the baseline mortality-adjusted survival after colon cancer resection.

Material and methods

In total, 523 patients with adenocarcinoma of the colon who underwent primary colon resection at Kantonsspital St. Gallen, Switzerland, between 1996 and 2008 were included.

Results

The median follow-up was 25 months for all patients and 39 months for those who survived until the end of the follow-up. The 5-year relative survival rate was 63.2 % (95 % CI 57.3–69.6 %), and the overall survival rate was 52 % (95 % CI 47.6–57.7 %). After curative resection of stage I–III colon cancer, 40 % of the observed deaths were cancer-related and 60 % reflected the baseline mortality. In stage I, the 5-year relative survival was 103.2 % (95 % CI 91.4–116.5 %) and was not different from a matched population (p = 0.820). In multivariate analysis, good general health and less advanced cancer stages were associated with better relative and overall survival rates. A more advanced age was associated with better relative survival, but worse overall survival.

Conclusions

The analysis of relative survival of patients exclusively with colon cancer revealed that prognosis of patients suffering from stage I colon cancer does not differ significantly from that of the general population. In more advanced stages, a relevant fraction of deaths is not cancer-related. As the stage determines a patient’s survival, early diagnosis is crucial for prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. GLOBOCAN 12: Estimated cancer incidence, mortality and prevalence worldwide in 2012. (2012) International Agency for research on cancer; WHO. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed 21.9.2014 2014

  2. Faivre J, Lemmens VE, Quipourt V, Bouvier AM (2007) Management and survival of colorectal cancer in the elderly in population-based studies. Eur J Cancer 43:2279–2284. doi:10.1016/j.ejca.2007.08.008

    Article  CAS  PubMed  Google Scholar 

  3. Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62:220–241. doi:10.3322/caac.21149

    Article  PubMed  Google Scholar 

  4. Begg CB, Schrag D (2002) Attribution of deaths following cancer treatment. J Natl Cancer Inst 94:1044–1045

    Article  PubMed  Google Scholar 

  5. Tarantino I, Achermann P, Guller U, Ulrich A, Schmied BM, Horber D, Cerny T, Stanga Z, Warschkow R (2013) Relative survival is an adequate estimate of cancer-specific survival: baseline mortality-adjusted 10-year survival of 771 rectal cancer patients. Ann Surg Oncol 20:3877–3884. doi:10.1245/s10434-013-3173-5

    Article  PubMed  Google Scholar 

  6. Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, Nur U, Tracey E, Coory M, Hatcher J, McGahan CE, Turner D, Marrett L, Gjerstorff ML, Johannesen TB, Adolfsson J, Lambe M, Lawrence G, Meechan D, Morris EJ, Middleton R, Steward J, Richards MA (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377:127–138. doi:10.1016/S0140-6736(10)62231-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mitry E, Guiu B, Cosconea S, Jooste V, Faivre J, Bouvier AM (2010) Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut 59:1383–1388. doi:10.1136/gut.2010.211557

    Article  PubMed  Google Scholar 

  8. Iversen LH, Norgaard M, Jepsen P, Jacobsen J, Christensen MM, Gandrup P, Madsen MR, Laurberg S, Wogelius P, Sorensen HT (2007) Trends in colorectal cancer survival in northern Denmark: 1985-2004. Color Dis 9:210–217. doi:10.1111/j.1463-1318.2006.01130.x

    Article  CAS  Google Scholar 

  9. Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J, Zund M (2009) Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol 35:1060–1064. doi:10.1016/j.ejso.2009.02.011

    Article  CAS  PubMed  Google Scholar 

  10. Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I (2011) Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol 18:2772–2782. doi:10.1245/s10434-011-1696-1

    Article  PubMed  Google Scholar 

  11. Warschkow R, Guller U, Koberle D, Muller SA, Steffen T, Thurnheer M, Schmied BM, Tarantino I (2014) Perioperative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg 259:131–138. doi:10.1097/SLA.0b013e318287ab4d

    Article  PubMed  Google Scholar 

  12. Warschkow R, Tarantino I, Torzewski M, Naf F, Lange J, Steffen T (2011) Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients. Int J Color Dis 26:1405–1413. doi:10.1007/s00384-011-1262-0

    Article  Google Scholar 

  13. Steffen T, Tarantino I, Hetzer FH, Warschkow R, Lange J, Zund M (2008) Safety and morbidity after ultra-low coloanal anastomoses: J-pouch vs end-to-end reconstruction. Int J Color Dis 23:277–281. doi:10.1007/s00384-007-0414-8

    Article  Google Scholar 

  14. Herfarth C, Runkel N (1994) Surgical standards in primary colon cancer. Chirurg 65:514–523

    CAS  PubMed  Google Scholar 

  15. Schweizerische Eidgenossenschaft BfS (2010) Jährliche sterbetafeln. http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/06/blank/dos/la_mortalite_en_suisse/tabl02.html. Accessed July 12 2012

  16. Ederer F, Axtell LM, Cutler SJ (1961) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121

    CAS  PubMed  Google Scholar 

  17. Pohar M, Stare J (2007) Making relative survival analysis relatively easy. Comput Biol Med 37:1741–1749. doi:10.1016/j.compbiomed.2007.04.010

    Article  PubMed  Google Scholar 

  18. Stare J, Pohar M, Henderson R (2005) Goodness of fit of relative survival models. Stat Med 24:3911–3925. doi:10.1002/sim.2414

    Article  PubMed  Google Scholar 

  19. Andersen PK, Borch-Johnsen K, Deckert T, Green A, Hougaard P, Keiding N, Kreiner S (1985) A Cox regression model for the relative mortality and its application to diabetes mellitus survival data. Biometrics 41:921–932

    Article  CAS  PubMed  Google Scholar 

  20. Danieli C, Remontet L, Bossard N, Roche L, Belot A (2012) Estimating net survival: the importance of allowing for informative censoring. Stat Med 31:775–786. doi:10.1002/sim.4464

    Article  PubMed  Google Scholar 

  21. Murthy VH, Krumholz HM, Gross CP (2004) Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291:2720–2726. doi:10.1001/jama.291.22.2720

    Article  CAS  PubMed  Google Scholar 

  22. Tarantino I, Muller SA, Warschkow R, Kulu Y, Schmied BM, Buchler MW, Ulrich A (2014) Baseline mortality-adjusted survival in resected rectal cancer patients. J Gastrointest Surg 18:1837–1844. doi:10.1007/s11605-014-2618-x

    Article  PubMed  Google Scholar 

  23. Cutler SJ, Axtell LM, Schottenfeld D (1969) Adjustment of long-term survival rates for deaths due to intercurrent disease. J Chronic Dis 22:485–491

    Article  CAS  PubMed  Google Scholar 

  24. Ashworth TG (1991) Inadequacy of death certification: proposal for change. J Clin Pathol 44:265–268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bieri U, Moch H, Dehler S, Korol D, Rohrmann S (2015) Changes in autopsy rates among cancer patients and their impact on cancer statistics from a public health point of view: a longitudinal study from 1980 to 2010 with data from Cancer Registry Zurich. Virchows Arch 466:637–643. doi:10.1007/s00428-015-1734-7

    Article  PubMed  Google Scholar 

  26. Gondos A, Bray F, Brewster DH, Coebergh JW, Hakulinen T, Janssen-Heijnen ML, Kurtinaitis J, Brenner H (2008) Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries. Eur J Cancer 44:1463–1475. doi:10.1016/j.ejca.2008.03.010

    Article  CAS  PubMed  Google Scholar 

  27. Gamel JW, Vogel RL (2001) Non-parametric comparison of relative versus cause-specific survival in Surveillance, Epidemiology and End Results (SEER) programme breast cancer patients. Stat Methods Med Res 10:339–352

    Article  CAS  PubMed  Google Scholar 

  28. Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB (2000) Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 284:3028–3035

    Article  CAS  PubMed  Google Scholar 

  29. Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, E Silva GA, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756. doi:10.1016/S1470-2045(08)70179-7

    Article  PubMed  Google Scholar 

  30. Gatta G, Ciccolallo L, Capocaccia R, Coleman MP, Hakulinen T, Moller H, Berrino F (2003) Differences in colorectal cancer survival between European and US populations: the importance of sub-site and morphology. Eur J Cancer 39:2214–2222

    Article  CAS  PubMed  Google Scholar 

  31. Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, Parkin DM, Wardle J, Duffy SW, Cuzick J (2010) Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375:1624–1633. doi:10.1016/S0140-6736(10)60551-X

    Article  PubMed  Google Scholar 

  32. Zbuk K, Sidebotham EL, Bleyer A, La Quaglia MP (2009) Colorectal cancer in young adults. Semin Oncol 36:439–450. doi:10.1053/j.seminoncol.2009.07.008

    Article  PubMed  Google Scholar 

  33. O'Connell JB, Maggard MA, Livingston EH, Yo CK (2004) Colorectal cancer in the young. Am J Surg 187:343–348. doi:10.1016/j.amjsurg.2003.12.020

    Article  PubMed  Google Scholar 

  34. Schellerer VS, Merkel S, Schumann SC, Schlabrakowski A, Fortsch T, Schildberg C, Hohenberger W, Croner RS (2012) Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer: CRC in patients under 50 years of age. Int J Color Dis 27:71–79. doi:10.1007/s00384-011-1291-8

    Article  Google Scholar 

Download references

Authors’ contributions

KU: Study conception and design, acquisition of data, drafting of manuscript, critical revision of manuscript. MZ: Drafting of manuscript, critical revision of manuscript. RW: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript. SM: Drafting of manuscript, critical revision of manuscript. BMS: Drafting of manuscript, critical revision of manuscript. LM: Study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Kristjan Ukegjini, Marcel Zadnikar, Rene Warschkow, Sascha Müller, Bruno M. Schmied & Lukas Marti

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

    Rene Warschkow

  3. Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany

    Lukas Marti

Authors
  1. Kristjan Ukegjini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Zadnikar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rene Warschkow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sascha Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno M. Schmied
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lukas Marti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lukas Marti.

Ethics declarations

Conflicts of interest

None of the authors of this manuscript has any direct or indirect commercial financial incentive associated with the publication of this paper. The funding involved in this work has been provided by our institution.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ukegjini, K., Zadnikar, M., Warschkow, R. et al. Baseline mortality-adjusted survival in colon cancer patients. Langenbecks Arch Surg 401, 633–641 (2016). https://doi.org/10.1007/s00423-016-1432-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1432-1

Keywords

Search

Navigation