Skip to main content

Advertisement

SpringerLink
Log in

Changes in disease pattern and treatment outcome of colorectal cancer: a review of 5,474 cases in 20 years

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Colorectal cancer (CRC) is the third most common cause of cancer-related death in Taiwan. During the past 20 years, several advances have improved the treatment outcome and quality of life of CRC patients. The purpose of this study was to identify the changes in the clinicopathological features and outcome of CRC over this period.

Materials and methods

Based on the computerized database of the Taipei Veterans General Hospital, between January 1981 and December 2000, 5,474 CRC patients were identified and divided into 2 groups based on the date of treatment (1981–1990 and 1991–2000). The clinicopathological features, outcome, and prognostic factors were analyzed and compared.

Results/findings

The age at onset of cancer was 61 years in the 1980s group and 66 years in the 1990s group. The frequency of rectal tumors decreased from 50% in the 1980s group to 44% in the 1990s group. Tumor, nodes, metastasis (TNM) stage distribution, surgical mortality, and anastomosis leakage were similar in the two groups. However, the 5-year overall survival rate was better in the 1990s group (56%) than that in the 1980s group (50%, P = 0.001). For rectal cancer patients, the local recurrence rate was lower in the 1990s group (6%) than that in the 1980s group (10%, P < 0.01). In stage III CRC, the 5-year overall survival rate was significantly higher in the 1990s group (54%) than that in the 1980s group (48%, P = 0.011). TNM stage was the most important independent prognostic factor for overall and disease-free survivals, followed by differentiation grade, CEA level, and treatment period.

Interpretation/conclusion

Advances in surgical technique and more standard use of chemotherapy have improved CRC outcome.

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

Similar content being viewed by others

References

  1. Weitz J, Koch M, Debus J et al (2005) Colorectal cancer. Lancet 365:153–165

    Article  PubMed  Google Scholar 

  2. Health and Vital Statistics (2000) Department of Health, ROC, Taipei

  3. Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994

    PubMed  CAS  Google Scholar 

  4. Gill S, Loprinzi CL, Sargent DJ et al (2004) Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 22:1797–1806

    Article  PubMed  CAS  Google Scholar 

  5. Marsoni S, International Multicenter Pooled Analysis of Colon Cancer Trials Investigators (2001) Efficacy of adjuvant fluorouracil and leucovorin in stage B2 and C colon cancer. International Multicenter Pooled Analysis of Colon Cancer Trials Investigators. Semin Oncol 28:14–19

    Article  PubMed  CAS  Google Scholar 

  6. Dahlberg M, Pahlman L, Bergstrom R et al (1998) Improved survival in patients with rectal cancer: a population-based register study. Br J Surg 85:515–520

    Article  PubMed  CAS  Google Scholar 

  7. Enker WE, Thaler HT, Cranor ML et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346

    PubMed  CAS  Google Scholar 

  8. Zhao GP, Zhou ZG, Lei WZ et al (2005) Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin. World J Gastroenterol 11:319–322

    PubMed  Google Scholar 

  9. Rullier E, Laurent C, Bretagnol F et al (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469

    Article  PubMed  Google Scholar 

  10. Schiessel R, Novi G, Holzer B et al (2005) Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 48:1858–1865 (discussion 1865–1867)

    Article  PubMed  Google Scholar 

  11. American Joint Committee on Cancer (1997) AJCC cancer staging manual, 5th edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  12. Mostafa G, Matthews BD, Norton HJ et al (2004) Influence of demographics on colorectal cancer. Am Surg 70:259–264

    PubMed  Google Scholar 

  13. Mensink PB, Kolkman JJ, Van Baarlen J et al (2002) Change in anatomic distribution and incidence of colorectal carcinoma over a period of 15 years: clinical considerations. Dis Colon Rectum 45:1393–1396

    Article  PubMed  CAS  Google Scholar 

  14. Takada H, Ohsawa T, Iwamoto S et al (2002) Changing site distribution of colorectal cancer in Japan. Dis Colon Rectum 45:1249–1254

    Article  PubMed  Google Scholar 

  15. Newcomb PA, Norfleet RG, Storer BE et al (1992) Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84:1572–1575

    Article  PubMed  CAS  Google Scholar 

  16. Selby JV, Friedman GD, Quesenberry CP Jr et al (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326:653–657

    Article  PubMed  CAS  Google Scholar 

  17. Ransohoff DF, Lang CA (1993) Sigmoidoscopic screening in the 1990s. JAMA 269:1278–1281

    Article  PubMed  CAS  Google Scholar 

  18. Williams NS, Dixon MF, Johnston D (1983) Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg 70:150–154

    Article  PubMed  CAS  Google Scholar 

  19. Kameda K, Furusawa M, Mori M et al (1990) Proposed distal margin for resection of rectal cancer. Jpn J Cancer Res 81:100–104

    PubMed  CAS  Google Scholar 

  20. Simstein NL, Kovalcik PJ, Cross GH (1978) Colorectal carcinoma in patients less than 40 years old. Dis Colon Rectum 21:169–171

    Article  PubMed  CAS  Google Scholar 

  21. Qing SH, Rao KY, Jiang HY et al (2003) Racial differences in the anatomical distribution of colorectal cancer: a study of differences between American and Chinese patients. World J Gastroenterol 9:721–725

    PubMed  Google Scholar 

  22. Marble K, Banerjee S, Greenwald L (1992) Colorectal carcinoma in young patients. J Surg Oncol 51:179–182

    Article  PubMed  CAS  Google Scholar 

  23. Faivre-Finn C, Bouvier-Benhamiche AM, Phelip JM et al (2002) Colon cancer in France: evidence for improvement in management and survival. Gut 51:60–64

    Article  PubMed  CAS  Google Scholar 

  24. Finn-Faivre C, Maurel J, Benhamiche AM et al (1999) Evidence of improving survival of patients with rectal cancer in France: a population based study. Gut 44:377–381

    Article  PubMed  CAS  Google Scholar 

  25. Porter GA, Soskolne CL, Yakimets WW et al (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227:157–167

    Article  PubMed  CAS  Google Scholar 

  26. Smith JA, King PM, Lane RH et al (2003) Evidence of the effect of ‘specialization’ on the management, surgical outcome and survival from colorectal cancer in Wessex. Br J Surg 90:583–592

    Article  PubMed  CAS  Google Scholar 

  27. Scott KW, Grace RH (1989) Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 76:1165–1167

    Article  PubMed  CAS  Google Scholar 

  28. Maurel J, Launoy G, Grosclaude P et al (1998) Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study. Cancer 82:1482–1486

    Article  PubMed  CAS  Google Scholar 

  29. Shen M-Y, Lin J-K, Lin T-C et al (2003) Prognostic significance of lymph node metastasis in resected colorectal cancer. J Soc Colon Rectal Surgeon (Taiwan) 14:7–14

    Google Scholar 

  30. Buroker TR, O’Connell MJ, Wieand HS et al (1994) Randomized comparison of two schedules of fluorouracil and leucovorin in the treatment of advanced colorectal cancer. J Clin Oncol 12:14–20

    PubMed  CAS  Google Scholar 

  31. Francini G, Petrioli R, Lorenzini L et al (1994) Folinic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer. Gastroenterology 106:899–906

    PubMed  CAS  Google Scholar 

  32. Moertel CG (1994) Chemotherapy for colorectal cancer. N Engl J Med 330:1136–1142

    Article  PubMed  CAS  Google Scholar 

  33. Moertel CG, Fleming TR, Macdonald JS et al (1990) Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 322:352–358

    Article  PubMed  CAS  Google Scholar 

  34. Arkenau HT, Bermann A, Rettig K et al (2003) 5-Fluorouracil plus leucovorin is an effective adjuvant chemotherapy in curatively resected stage III colon cancer: long-term follow-up results of the adjCCA-01 trial. Ann Oncol 14:395–399

    Article  PubMed  CAS  Google Scholar 

  35. Sargent DJ, Goldberg RM, Jacobson SD et al (2001) A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 345:1091–1097

    Article  PubMed  CAS  Google Scholar 

  36. Potosky AL, Harlan LC, Kaplan RS et al (2002) Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol 20:1192–1202

    Article  PubMed  Google Scholar 

  37. Ayanian JZ, Zaslavsky AM, Fuchs CS et al (2003) Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol 21:1293–1300

    Article  PubMed  Google Scholar 

  38. Fata F, Mirza A, Craig G et al (2002) Efficacy and toxicity of adjuvant chemotherapy in elderly patients with colon carcinoma: a 10-year experience of the Geisinger Medical Center. Cancer 94:1931–1938

    Article  PubMed  CAS  Google Scholar 

  39. Iwashyna TJ, Lamont EB (2002) Effectiveness of adjuvant fluorouracil in clinical practice: a population-based cohort study of elderly patients with stage III colon cancer. J Clin Oncol 20:3992–3998

    Article  PubMed  CAS  Google Scholar 

  40. Jessup JM, Stewart A, Greene FL et al (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294:2703–2711

    Article  PubMed  CAS  Google Scholar 

  41. Fernando NH, Hurwitz HI (2003) Inhibition of vascular endothelial growth factor in the treatment of colorectal cancer. Semin Oncol 30:39–50

    PubMed  CAS  Google Scholar 

  42. O’Dwyer PJ, Benson AB 3rd (2002) Epidermal growth factor receptor-targeted therapy in colorectal cancer. Semin Oncol 29:10–17

    Article  PubMed  CAS  Google Scholar 

  43. Kitisin K, Mishra L (2006) Molecular biology of colorectal cancer: new targets. Semin Oncol 33(Suppl 11):14–23

    Article  CAS  Google Scholar 

  44. Wilson RH (2006) Novel therapeutic developments other than EGFR and VEGF inhibition in colorectal cancer. Oncologist 11:1018–1024

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, National Yang-Ming University, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China

    Jiun-Ho Ju, Shih-Ching Chang, Huann-Shen Wang, Shung-Haur Yang, Jen-Kae Jiang, Wei-Chone Chen, Tzu-Chen Lin,  Hung Hsu, Feng-Ming Wang & Jen-Kou Lin

  2. No. 201, Sec. 2, Shih-Pai Road 11217, Taipei, Taiwan, Republic of China

    Jen-Kou Lin

Authors
  1. Jiun-Ho Ju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shih-Ching Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huann-Shen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shung-Haur Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jen-Kae Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-Chone Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tzu-Chen Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hung Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Feng-Ming Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jen-Kou Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jen-Kou Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ju, JH., Chang, SC., Wang, HS. et al. Changes in disease pattern and treatment outcome of colorectal cancer: a review of 5,474 cases in 20 years. Int J Colorectal Dis 22, 855–862 (2007). https://doi.org/10.1007/s00384-007-0293-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-007-0293-z

Keywords

Search

Navigation