Treatment and survival of rectal cancer patients over the age of 80 years: a EURECCA international comparison

Yvette H M Claassen,Pawel Mroczkowski,Johanneke E A Portielje,Gerrit J Liefers,Hans Lippert,Arne Wibe,Fabian A Holman,Esther Bastiaannet,Elizabeth Van Eycken,Anna Martling,Tamara Vandendael,Lene H Iversen,Antonio Codina Cazador,Nina C A Vermeer,Cornelis J H Van De Velde,Marianne G Guren,Harm J T Rutten,Robert Johansson,Bjorn Moller

doi:10.1038/s41416-018-0215-6

Abstract

BackgroundThe optimal treatment strategy for older rectal cancer patients remains unclear. The current study aimed to compare treatment and survival of rectal cancer patients aged 80+.MethodsPatients of ≥80 years diagnosed with rectal cancer between 2001 and 2010 were included. Population-based cohorts from Belgium (BE), Denmark (DK), the Netherlands (NL), Norway (NO) and Sweden (SE) were compared side by side for neighbouring countries on treatment strategy and 5-year relative survival (RS), adjusted for sex and age. Analyses were performed separately for stage I–III patients and stage IV patients.ResultsOverall, 19 634 rectal cancer patients were included. For stage I–III patients, 5-year RS varied from 61.7% in BE to 72.3% in SE. Proportion of preoperative radiotherapy ranged between 7.9% in NO and 28.9% in SE. For stage IV patients, 5-year RS differed from 2.8% in NL to 5.6% in BE. Rate of patients undergoing surgery varied from 22.2% in DK to 40.8% in NO.ConclusionsSubstantial variation was observed in the 5-year relative survival between European countries for rectal cancer patients aged 80+, next to a wide variation in treatment, especially in the use of preoperative radiotherapy in stage I–III patients and in the rate of patients undergoing surgery in stage IV patients.

Highlights

Colorectal cancer is the second most common cancer in Europe and is the second cause of death from cancer, with an estimated number of 215 000 deaths in 2012 in Europe.[1]
Treatment guidelines vary between countries, most agree that patients with stage I disease (T12N0M0) should undergo surgery without neoadjuvant therapy, and that patients with locoregional advanced disease stages need neoadjuvant chemoradiotherapy
Stage I–III Swedish patients had a significant better survival than Danish and Norwegian patients

Summary

Introduction

Colorectal cancer is the second most common cancer in Europe and is the second cause of death from cancer, with an estimated number of 215 000 deaths in 2012 in Europe.[1]. The outcome of rectal cancer has improved dramatically after the introduction of total mesorectal excision (TME) surgery, the recognition and evaluation of the circumferential resection margin and after the introduction of neoadjuvant chemoradiotherapy.[4,5,6,7] treatment guidelines vary between countries, most agree that patients with stage I disease (T12N0M0) should undergo surgery without neoadjuvant therapy, and that patients with locoregional advanced disease stages need neoadjuvant chemoradiotherapy. Population-based cohorts from Belgium (BE), Denmark (DK), the Netherlands (NL), Norway (NO) and Sweden (SE) were compared side by side for neighbouring countries on treatment strategy and 5-year relative survival (RS), adjusted for sex and age. CONCLUSIONS: Substantial variation was observed in the 5-year relative survival between European countries for rectal cancer patients aged 80+, next to a wide variation in treatment, especially in the use of preoperative radiotherapy in stage I–III patients and in the rate of patients undergoing surgery in stage IV patients

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Results

Discussion

Conclusion