Prognosis of colon cancer compared with rectal cancer. Where lies the difference?

Bjørn S. Nedrebø

Stavanger University Hospital

Aim of the lecture

• Compare colon and rectal cancer in Norway

• Point out differences, short term and long term

• Quality of the surgical specimen of colon cancers in Norway

3

National Registry Introduction TME

1993/94

Colon CancerColon Cancer

Rx

T4, fixed

20001997

Cx

Stage III≤75 yrs

2003

MRI stagingCRM ≤3 mm

MDT

Rectal CancerRectal CancerColorectal Cancer in Norway

Evolution of Treatment RecommendationsColorectal Cancer in Norway

Evolution of Treatment Recommendations

N=31158 (100%)Metachronous

cancer; n=1486 (5%)N=29672( 95%)

N=20648 (66%)

Metastases; n=9024 (29%)

Minor resections;N=1595 (5%)

Study populationN=19053 (61%)

Patient Cohort

Norwegian Cancer Registry & Rectal Cancer Registry, 1994 – 2003

Method

• 5 year relative survival for all patients

• Excess mortality in different timeperiods

• Time periods(1) 1994-1996 (N=5400) (2) 2001-2003 (N=5870)

70% Colon cancer in both periods

Analysis

– Localisation• Rectum (≤ 15 cm from anal verge)• Colon

– Stage• N0 (T1-4, N0)

• N+ (T1-4, N1-2)

– Age: <75 vs. ≥75 year

Patient Characteristics

Improved survivalColon and rectal cancer

p<0.01 p<0.01

Colon Rektum

1994-1996

2001-2003

Fig 1 a-b: Early studyperiod vs late studyperiod

1a Colon cancer 1b Rectal cancer

Colon vs rectum

p<0.74 p<0.03

Early period Late period

ColonRectum

Fig 2 a-b. Coloncancer vs rectumcancer

2a Early period 2b Late period

Colon early vs late

N0 N+

1994-1996

2001-2003

Rectal cancer, early vs late

N0 N+

1994-1996

2001-2003

N+

Lymph node sampling as a proxy of surgical technique

• Included all patients in Norway 2007-2008 who were operated for adenocarcinoma in colon

• Lymph node sampling; % operations with ≥12 lymph nodes.

• 5068 coloncancer (100%)• 4145 (81%) underwent surgical resection.• 3733 patients (73%) with complete histopathologydata

• 73% ≥ 12 lymph nodes• 16% laparoscopy

Age

Age N ≥12 lymph nodes

<65 26% 74%

65-69 13% 74%

70-74 15% 66%

75-79 17% 66%

80-84 16% 65%

>85 13% 66%

Sex/localisation

Sex N ≥ 12 lymph nodes

Male 47% 67%

Female 53% 70%

Right colon 56% 74%

Left colon 44% 63%

Hospital volume

Hospital volume / year N % ≥ 12 lymph nodes

>60 59% 71%

40-59 26% 69%

20-39 5% 58%

10-20 7% 66%

<10 3% 60%

Elective vs acute

N ≥ 12 lymph nodes

Elective 84% 72%

Acute w/ obstruction 11% 64%

Acute w/ perforation <1% 64%

Multivariatanalyse

• ≥12 lymph nodes:

• Pasient <70 years

• Elective surgery

• High volume hospital

• pT >1

• Right sided resection

• Pathological template

Conclusion

Better survival for rectal cancer than colon cancerNeed to focus on colon cancer, especially

patients over 75 years

acute surgery

high volume hospitals(?)

standardised pathology template