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Relative Survival is an Adequate Estimate of Cancer-Specific Survival: Baseline Mortality-Adjusted 10-Year Survival of 771 Rectal Cancer Patients

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of the present investigation is to assess the baseline mortality-adjusted 10-year survival of rectal cancer patients.

Methods

Ten-year survival was analyzed in 771 consecutive American Joint Committee on Cancer (AJCC) stage I–IV rectal cancer patients undergoing open resection between 1991 and 2008 using risk-adjusted Cox proportional hazard regression models adjusting for population-based baseline mortality.

Results

The median follow-up of patients alive was 8.8 years. The 10-year relative, overall, and cancer-specific survival were 66.5 % [95 % confidence interval (CI) 61.3–72.1], 48.7 % (95 % CI 44.9–52.8), and 66.4 % (95 % CI 62.5–70.5), respectively. In the entire patient sample (stage I–IV) 47.3 % and in patients with stage I–III 33.6 % of all deaths were related to rectal cancer during the 10-year period. For patients with AJCC stage I rectal cancer, the 10-year overall survival was 96 % and did not significantly differ from an average population after matching for gender, age, and calendar year (p = 0.151). For the more advanced tumor stages, however, survival was significantly impaired (p < 0.001).

Conclusions

Retrospective investigations of survival after rectal cancer resection should adjust for baseline mortality because a large fraction of deaths is not cancer related. Stage I rectal cancer patients, compared to patients with more advanced disease stages, have a relative survival close to 100 % and can thus be considered cured. Using this relative-survival approach, the real public health burden caused by rectal cancer can reliably be analyzed and reported.

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Acknowledgment

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Ignazio Tarantino MD, MSc, Bruno M. Schmied MD & Rene Warschkow MD

  2. Department of Internal Medicine, Regionalspital Emmental, Langnau, Switzerland

    Philipp Achermann MD

  3. Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Ulrich Güller MD, MHS, Daniel Horber MD & Thomas Cerny MD

  4. University Clinic for Visceral Surgery and Medicine, University of Bern, Inselspital, Bern, Switzerland

    Ulrich Güller MD, MHS

  5. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany

    Alexis Ulrich MD

  6. Department of General Internal Medicine, University of Bern, Inselspital, Bern, Switzerland

    Zeno Stanga MD

  7. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Rene Warschkow MD

Authors
  1. Ignazio Tarantino MD, MSc
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  2. Philipp Achermann MD
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  3. Ulrich Güller MD, MHS
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  4. Alexis Ulrich MD
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  5. Bruno M. Schmied MD
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  9. Rene Warschkow MD
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Correspondence to Ignazio Tarantino MD, MSc.

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Tarantino, I., Achermann, P., Güller, U. et al. 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 (2013). https://doi.org/10.1245/s10434-013-3173-5

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  • DOI: https://doi.org/10.1245/s10434-013-3173-5

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