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Baseline Mortality-Adjusted Survival in Resected Rectal Cancer Patients

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

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

Methods

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Ignazio Tarantino, Sascha A. Müller, Yakup Kulu, Markus W. Büchler & Alexis Ulrich

  2. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Sascha A. Müller, Rene Warschkow & Bruno M. Schmied

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

    Rene Warschkow

Authors
  1. Ignazio Tarantino
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  2. Sascha A. Müller
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  3. Rene Warschkow
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  4. Yakup Kulu
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  5. Bruno M. Schmied
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  6. Markus W. Büchler
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  7. Alexis Ulrich
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Correspondence to Alexis Ulrich.

Additional information

Ignazio Tarantino and Sascha A. Müller contributed equally.

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Tarantino, I., Müller, S.A., Warschkow, R. et al. Baseline Mortality-Adjusted Survival in Resected Rectal Cancer Patients. J Gastrointest Surg 18, 1837–1844 (2014). https://doi.org/10.1007/s11605-014-2618-x

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  • DOI: https://doi.org/10.1007/s11605-014-2618-x

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