Journal of Gastrointestinal Surgery

, Volume 18, Issue 10, pp 1837–1844 | Cite as

Baseline Mortality-Adjusted Survival in Resected Rectal Cancer Patients

  • Ignazio Tarantino
  • Sascha A. Müller
  • Rene Warschkow
  • Yakup Kulu
  • Bruno M. Schmied
  • Markus W. Büchler
  • Alexis Ulrich
Original Article



This investigation assessed the baseline mortality-adjusted 5-year survival after open rectal cancer resection.


The 5-year survival rate was analyzed in 885 consecutive American Joint Committee on Cancer (AJCC) stage I–IV rectal cancer patients undergoing open resection between 2002 and 2011 using risk-adjusted Cox proportional hazards regression models adjusted for population-based baseline mortality.


The 5-year relative and overall survival rates were 80.9 %(95 % confidence interval (CI): 77.0–85.0 %) and 71.9 %(95 % CI, 68.4–75.5 %), respectively. The 5-year relative survival rates for stage I, II, III, and IV cancer were 97.8 % (95 % CI, 93.1–102.8 %), 90.9 %(95 % CI, 84.3–98.1 %), 72.0 % (95 % CI, 64.7–80.1 %), and 24.4 % (95 % CI: 16.0–37.0 %), respectively. After the curative resection of stage I–III rectal cancer, fewer than every other observed death was cancer-related. The 5-year relative survival rate for stage I cancer did not differ from the matched average national baseline mortality rate (P = 0.419). Higher age (hazard ratio (HR) 0.94, 95 % CI: 0.92–0.95, P < 0.001) was protective for relative survival but unfavorable for overall survival (HR 1.04, 95 % CI: 1.02–1.05, P < 0.001). Female gender was only unfavorable for relative survival (HR 1.59, 95 % CI: 1.11–2.29, P = 0.014).


The analysis of relative survival in a large cohort of rectal cancer patients revealed that stage I rectal cancer is fully curable. The findings regarding age and gender may explain the conflicting results obtained to date from studies based on overall survival.


Relative survival Survival Rectal cancer 


Sources of Financial Support


Conflicts of Interest



  1. 1.
    Baras N, B. B, Bertz J, Dahm S, Haberland J, Kraywinkel K, Laudi A, Wold U. Chapter 3.5: Darm. In Krebs in Deutschland 2007/2008, 8th ed. Berlin: Robert Koch-Institut, 2012, pp36-39.Google Scholar
  2. 2.
    Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 2004; 291: 2720-2726.PubMedCrossRefGoogle Scholar
  3. 3.
    Golan T, Urban D, Berger R, Lawrence YR. Changing prognosis of metastatic colorectal adenocarcinoma: Differential improvement by age and tumor location. Cancer 2013; 119: 3084-3091.PubMedCrossRefGoogle Scholar
  4. 4.
    Robinson D, Sankila R, Hakulinen T, Moller H. Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates. Eur J Cancer 2007; 43: 909-913.PubMedCrossRefGoogle Scholar
  5. 5.
    Yu XQ, O'Connell DL, Gibberd RW, Abrahamowicz M, Armstrong BK. Misclassification of colorectal cancer stage and area variation in survival. Int J Cancer 2008; 122: 398-402.PubMedCrossRefGoogle Scholar
  6. 6.
    Tarantino I, Achermann P, Guller U, Ulrich A, Schmied BM, Horber D, Cerny T, Stanga Z, Warschkow R. Relative Survival is an Adequate Estimate of Cancer-Specific Survival: Baseline Mortality-Adjusted 10-Year Survival of 771 Rectal Cancer Patients. Ann Surg Oncol 2013; 20: 3877-3884.PubMedCrossRefGoogle Scholar
  7. 7.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, A. T. AJCC Cancer Staging Manual. New York: Springer; 2010.Google Scholar
  8. 8.
    Destatis: Staat & Gesellschaft - Sterbefälle - Sterbetafel 2009/11 - Wiesbaden, Germany: Statistisches Bundesamt (Federal Statistical Office); 2013.Google Scholar
  9. 9.
    Pohar M, Stare J. Making relative survival analysis relatively easy. Comput Biol Med 2007; 37: 1741-1749.PubMedCrossRefGoogle Scholar
  10. 10.
    Andersen PK, Borch-Johnsen K, Deckert T, Green A, Hougaard P, Keiding N, Kreiner S. A Cox regression model for the relative mortality and its application to diabetes mellitus survival data. Biometrics 1985; 41: 921-932.PubMedCrossRefGoogle Scholar
  11. 11.
    Danieli C, Remontet L, Bossard N, Roche L, Belot A. Estimating net survival: the importance of allowing for informative censoring. Stat Med 2012; 31: 775-786.PubMedCrossRefGoogle Scholar
  12. 12.
    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, GA ES, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL, Group CW. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008; 9: 730-756.Google Scholar
  13. 13.
    Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, Santaquilani M, group EW. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007; 8: 773-783.PubMedCrossRefGoogle Scholar
  14. 14.
    Gondos A, Bray F, Brewster DH, Coebergh JW, Hakulinen T, Janssen-Heijnen ML, Kurtinaitis J, Brenner H, Group ESW. Recent trends in cancer survival across Europe between 2000 and 2004: a model-based period analysis from 12 cancer registries. Eur J Cancer 2008; 44: 1463-1475.PubMedCrossRefGoogle Scholar
  15. 15.
    Karim-Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 2008; 44: 1345-1389.PubMedCrossRefGoogle Scholar
  16. 16.
    Gobbi PG, Valentino F, Berardi E, Tronconi C, Brugnatelli S, Luinetti O, Moratti R, Corazza GR. New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer. Br J Cancer 2008; 98: 328-334.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90.PubMedCrossRefGoogle Scholar
  18. 18.
    Rutherford MJ, Dickman PW, Lambert PC. Comparison of methods for calculating relative survival in population-based studies. Cancer Epidemiol 2012; 36: 16-21.PubMedCrossRefGoogle Scholar
  19. 19.
    Schellerer VS, Merkel S, Schumann SC, Schlabrakowski A, Fortsch T, Schildberg C, Hohenberger W, Croner RS. Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer : CRC in patients under 50 years of age. Int J Colorectal Dis 2012; 27: 71-79.PubMedCrossRefGoogle Scholar
  20. 20.
    Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS, Wang SM. Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 2003; 90: 205-214.PubMedCrossRefGoogle Scholar
  21. 21.
    Karsten B, Kim J, King J, Kumar RR. Characteristics of colorectal cancer in young patients at an urban county hospital. Am Surg 2008; 74: 973-976.PubMedGoogle Scholar
  22. 22.
    Zbuk K, Sidebotham EL, Bleyer A, La Quaglia MP. Colorectal cancer in young adults. Semin Oncol 2009; 36: 439-450.PubMedCrossRefGoogle Scholar
  23. 23.
    O'Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Do young colon cancer patients have worse outcomes? World J Surg 2004; 28: 558-562.PubMedCrossRefGoogle Scholar
  24. 24.
    O'Connell JB, Maggard MA, Livingston EH, Yo CK. Colorectal cancer in the young. Am J Surg 2004; 187: 343-348.PubMedCrossRefGoogle Scholar
  25. 25.
    Bedikian AY, Kantarjian H, Nelson RS, Stroehlein JR, Bodey GP. Colorectal cancer in young adults. South Med J 1981; 74: 920-924.PubMedCrossRefGoogle Scholar
  26. 26.
    Turkiewicz D, Miller B, Schache D, Cohen J, Theile D. Young patients with colorectal cancer: how do they fare? ANZ J Surg 2001; 71: 707-710.PubMedCrossRefGoogle Scholar
  27. 27.
    Chung YF, Eu KW, Machin D, Ho JM, Nyam DC, Leong AF, Ho YH, Seow-Choen F. Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 1998; 85: 1255-1259.PubMedCrossRefGoogle Scholar
  28. 28.
    Mitry E, Douillard JY, Van Cutsem E, Cunningham D, Magherini E, Mery-Mignard D, Awad L, Rougier P. Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients included in irinotecan phase III trials. Ann Oncol 2004; 15: 1013-1017.PubMedCrossRefGoogle Scholar
  29. 29.
    Latkauskas T, Rudinskaite G, Kurtinaitis J, Janciauskiene R, Tamelis A, Saladzinskas Z, Pavalkis D. The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment. BMC Cancer 2005; 5: 153.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Hendifar A, Yang D, Lenz F, Lurje G, Pohl A, Lenz C, Ning Y, Zhang W, Lenz HJ. Gender disparities in metastatic colorectal cancer survival. Clin Cancer Res 2009; 15: 6391-6397.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Nguyen SP, Bent S, Chen YH, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7: 676-681 e671-673.Google Scholar
  32. 32.
    Brenner H, Haug U, Hundt S. Sex differences in performance of fecal occult blood testing. Am J Gastroenterol 2010; 105: 2457-2464.PubMedCrossRefGoogle Scholar
  33. 33.
    Kuntz KM, Weinstein MC. Life expectancy biases in clinical decision modeling. Med Decis Making 1995; 15: 158-169.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Ignazio Tarantino
    • 1
  • Sascha A. Müller
    • 1
    • 2
  • Rene Warschkow
    • 2
    • 3
  • Yakup Kulu
    • 1
  • Bruno M. Schmied
    • 2
  • Markus W. Büchler
    • 1
  • Alexis Ulrich
    • 1
  1. 1.Department of General, Abdominal and Transplant SurgeryUniversity of HeidelbergHeidelbergGermany
  2. 2.Department of SurgeryKantonsspital St. GallenSt. GallenSwitzerland
  3. 3.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

Personalised recommendations