COLORECTAL CANCER

Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery

L Ciccolallo¹, R Capocaccia², M P Coleman³, F Berrino¹, J W W Coebergh⁴, R A M Damhuis⁵, J Faivre⁶, C Martinez-Garcia⁷, H Møller⁸, M Ponz de Leon⁹, G Launoy¹⁰, N Raverdy¹¹, E M I Williams¹² and G Gatta¹

¹ Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
² Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy
³ London School of Hygiene and Tropical Medicine, London, UK
⁴ Eindhoven Cancer Registry, Eindhoven, the Netherlands
⁵ Rotterdam Cancer Registry, Rotterdam, the Netherlands
⁶ Côte d’Or Cancer Registry, University of Dijon, France
⁷ Granada Cancer Registry, EASP, Granada, Spain
⁸ Thames Cancer Registry, UK
⁹ Modena Colorectal Cancer Registry, Università di Modena, Italy
¹⁰ Calvados Digestive Cancer Registry, Caen, France
¹¹ Somme Cancer Registry, France
¹² Merseyside and Cheshire Cancer Registry, Liverpool, UK

Correspondence to:
Correspondence to:
Dr L Ciccolallo
Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133 Milan, Italy; ciccolallo{at}istitutotumori.mi.it

Background: Population based colorectal cancer survival among patients diagnosed in 1985–89 was lower in Europe than in the USA (45% v 59% five year relative survival).

Aims: To explain this difference in survival using a new analytic approach for patients diagnosed between 1990 and 1991.

Subjects: A total of 2492 European and 11 191 US colorectal adenocarcinoma patients registered by 10 European and nine US cancer registries.

Methods: We obtained clinical information on disease stage, number of lymph nodes examined, and surgical treatment. We analysed three year relative survival, calculating relative excess risks of death (RERs, referent category US patients) adjusted for age, sex, site, surgery, stage, and number of nodes examined, using a new multivariable approach.

Results: We found that 85% of European patients and 92% of US patients underwent surgical resection. Three year relative survival was 69% for US patients and 57% for European patients. After adjustment for age, sex, and site, the RER was significantly high in all 10 European populations, ranging from 1.07 (95% confidence interval 0.86–1.32) (Modena, Italy) to 2.22 (1.79–2.76) (Thames, UK). After further adjustment for stage, surgical resection, and number of nodes examined (a determinant of stage), RERs ranged from 0.77 (0.62–0.96) to 1.59 (1.28–1.97). For some European registries the excess risk was small and not statistically significant.

Conclusions: US-Europe survival differences in colorectal cancer are large but seem to be mostly attributable to differences in stage at diagnosis. There are wide variations in diagnostic and surgical practice between Europe and the USA.

Abbreviations: RER, relative excess risk; F, France; I, Italy; E, Spain; NL, The Netherlands; UK, United Kingdom; US, United States; DCO, death certificate only; FOBT, faecal occult blood test

Keywords: colorectal cancer; population based cancer registries; surgery; lymph nodes; survival; USA; Europe

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller
Gut 2005 54: 175. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Gao, R.-N., Neutel, C. I., Wai, E. (2008). Gender differences in colorectal cancer incidence, mortality, hospitalizations and surgical procedures in Canada. J Public Health (Oxf) 30: 194-201 [Abstract] [Full Text]  
• Williams, J G, Roberts, S E, Ali, M F, Cheung, W Y, Cohen, D R, Demery, G, Edwards, A, Greer, M, Hellier, M D, Hutchings, H A, Ip, B, Longo, M F, Russell, I T, Snooks, H A, Williams, J C (2007). Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence. Gut 56: 1-113 [Full Text]  
• Woods, L. M., Rachet, B., Coleman, M. P. (2006). Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 17: 5-19 [Abstract] [Full Text]