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Clinical Characteristics and Outcomes in Patients with Advanced Rectal Cancer: A National Prospective Cohort Study

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Diseases of the Colon & Rectum

Purpose

At the time of diagnosis, approximately one third of patients with rectal cancer present with advanced disease. In this study we focus on a group of patients with primary advanced rectal cancer considered as not operable. We address various clinical aspects relevant for decision-making in a group of patients in need of palliative care.

Methods

Between January 1997 and December 2001, 4831 consecutive patients with rectal cancer were prospectively registered in the Norwegian Rectal Cancer Registry. In this national population-based cohort, 386 patients (8 percent) without surgical interventions were identified. These patients comprise the study population. Clinical characteristics and survivals were addressed.

Results

Patients not surgically treated were significantly older compared with other treatment groups (median age, 80 years; interquartile range, 72–86 vs. median age, 71 years; interquartile range, 62–79 years) (P<0.001). Median survival time was 4.5 (range, 3.5–5.4) months, regardless of age, gender, or hospital category. Patients who received radiotherapy had a significantly increased survival (P<0.001) compared with patients not treated with radiation, with a median survival time of 10.2 (range, 7.3–12.1) months vs. 2.8 (range, 2.1–3.6) months, respectively. Use of chemotherapy was not associated with improved survival. In multivariate analysis, only stage of disease and radiotherapy were independent predictors of better survival.

Conclusion

Higher age and comorbidity seem to influence choice of treatment in this subgroup of patients with advanced rectal cancer disease. In nonsurgically treated patients, radiotherapy was associated with an improved survival. Our prospective, population-based cohort study emphasizes the dismal prognosis of these patients, which also should challenge our efforts and clinical approaches in palliative care.

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Acknowledgments

The authors are grateful for the mutual cooperation and support provided by fellow surgeons within the network of the Norwegian Rectal Cancer Registry.

Author information

Author notes

  1. Helgi Kjartan Sigurdsson M.D., Arne Skarstein M.D., Ph.D. & Jon Arne Søreide M.D., Ph.D.,

    Present address: Department of Surgical Sciences, University of Bergen, Bergen, Norway

  2. Hartwig Körner M.D., Ph.D.

    Present address: Regional Centre of Excellence for Palliative Care Western Norway, Haukeland University Hospital, Bergen, Norway

Authors and Affiliations

  1. Department of Surgery, Stavanger University Hospital, Stavanger, Norway

    Helgi Kjartan Sigurdsson M.D., Hartwig Körner M.D., Ph.D. & Jon Arne Søreide M.D., Ph.D.,

  2. Section of Oncology, Institute of Medicine, University of Bergen, Bergen, Norway

    Olav Dahl M.D., Ph.D.

  3. Department of Oncology, Haukeland University Hospital, Bergen, Norway

    Olav Dahl M.D., Ph.D.

  4. Department of Surgery, Haukeland University Hospital, Bergen, Norway

    Arne Skarstein M.D., Ph.D.

  5. Department of Surgical Sciences, University of Bergen, Bergen, Norway

    Hartwig Körner M.D., Ph.D.

Authors
  1. Helgi Kjartan Sigurdsson M.D.
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Consortia

On behalf of The Norwegian Rectal Cancer Group

Corresponding author

Correspondence to Jon Arne Søreide M.D., Ph.D.,.

Additional information

Dr. H. K. Sigurdsson, M.D., is a Reseach Fellow sponsored by the Western Norwegian Regional Health Authorities (Project No. 911158).

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Sigurdsson, H.K., Körner, H., Dahl, O. et al. Clinical Characteristics and Outcomes in Patients with Advanced Rectal Cancer: A National Prospective Cohort Study. Dis Colon Rectum 50, 285–291 (2007). https://doi.org/10.1007/s10350-006-0770-4

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  • DOI: https://doi.org/10.1007/s10350-006-0770-4

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