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Colorectal disease
Understanding variations in survival for colorectal cancer in Europe: a EUROCARE high resolution study
  1. G Gattaa,
  2. R Capocacciab,
  3. M Santa,
  4. C M J Bellc,
  5. J W W Coeberghd,
  6. R A M Damhuise,
  7. J Faivref,
  8. C Martinez-Garciag,
  9. J Pawlegah,
  10. M Ponz de Leoni,
  11. D Pottierj,
  12. N Raverdyk,
  13. E M I Williamsl,
  14. F Berrinoa
  1. aDivision of Epidemiology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy, bLaboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy, cThames Cancer Registry, UK, dEindhoven Cancer Registry, Eindhoven, Netherlands, eRotterdam Cancer Registry, Rotterdam, Netherlands, fCôte d'Or Cancer Registry, University of Dijon, France, gGranada Cancer Registry, EASP, Granada, Spain , hDepartment of Oncology, Jagiellanian Unversity, Krakow, Poland, iModena Colorectal Cancer Registry, Università di Modena, Italy, jCalvados Digestive Cancer Registry, Caen, France, kSomme Cancer Registry, France, lMerseyside and Cheshire Cancer Registry, Liverpool, UK
  1. Dr G Gatta, Divisione di Epidemiologia, Istituto Nazionale per la Cura e lo Studio dei Tumori, Via Venezian, 1, 20133 Milano, Italy. Email:gatta{at}istitutotumori.mi.it

Abstract

BACKGROUND Marked differences in population based survival across Europe were found for colorectal cancers diagnosed in 1985–1989.

AIMS To understand the reasons for these differences in survival in a new analysis of colorectal cancers diagnosed between 1988 and 1991.

SUBJECTS A total of 2720 patients with adenocarcinoma of the large bowel from 11 European cancer registries (CRs).

METHODS We obtained information on stage at diagnosis, diagnostic determinants, and surgical treatment (not routinely collected by CRs) and analysed the data in relation to three year observed survival, calculating relative risks (RRs) of death and adjusting for age, sex, site, stage, and determinants of stage.

RESULTS Three year observed survival rates ranged from 25% (Cracow) to 59% (Modena), and were low in the Thames area (UK) (38%). Survival rates between registries for “resected” patients varied less than those for all patients. When age, sex, and site were considered, RRs ranged from 0.7 (95% confidence intervals (CI) 0.6–0.9) (Modena) to 2.3 (95% CI 1.9–2.9) (Cracow). After further adjustment by stage, between registry RR variation was between 0.8 (95% CI 0.6–0.9) and 1.8 (95% CI 1.5-2.2). Inter-registry RR differences were slightly reduced when the determinants of stage (number of nodes examined and liver imaging) were included in the model. The reduction was marked for the UK registries.

CONCLUSIONS The wide differences across Europe in colorectal cancer survival depend to a large extent on differences in stage at diagnosis. There are wide variations in diagnostic and surgical practices. There was a twofold range in the risk of death from colorectal cancer even after adjustment for surgery and disease stage.

  • colorectal cancer
  • population based cancer registries
  • stage at diagnosis
  • survival
  • surgery
  • Europe

  • Abbreviations used in this paper

    CRs
    cancer registries
    RR
    relative risk

    • https://doi.org/10.1136/gut.47.4.533

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    • Abbreviations used in this paper

      CRs
      cancer registries
      RR
      relative risk
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