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Schiergens TS, Drefs M, Dörsch M, Kühn F, Albertsmeier M, Niess H, Schoenberg MB, Assenmacher M, Küchenhoff H, Thasler WE, Guba MO, Angele MK, Rentsch M, Werner J, Andrassy J. Prognostic Impact of Pedicle Clamping during Liver Resection for Colorectal Metastases. Cancers (Basel) 2020; 13:E72. [PMID: 33383844 PMCID: PMC7795154 DOI: 10.3390/cancers13010072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/25/2022] Open
Abstract
Pedicle clamping (PC) during liver resection for colorectal metastases (CRLM) is used to reduce blood loss and allogeneic blood transfusion (ABT). The effect on long-term oncologic outcomes is still under debate. A retrospective analysis of the impact of PC on ABT-demand regarding overall (OS) and recurrence-free survival (RFS) in 336 patients undergoing curative resection for CRLM was carried out. Survival analysis was performed by both univariate and multivariate methods and propensity-score (PS) matching. PC was employed in 75 patients (22%). No increased postoperative morbidity was monitored. While the overall ABT-rate was comparable (35% vs. 37%, p = 0.786), a reduced demand for more than two ABT-units was observed (p = 0.046). PC-patients had better median OS (78 vs. 47 months, p = 0.005) and RFS (36 vs. 23 months, p = 0.006). Multivariate analysis revealed PC as an independent prognostic factor for OS (HR = 0.60; p = 0.009) and RFS (HR = 0.67; p = 0.017). For PC-patients, 1:2 PS-matching (N = 174) showed no differences in the overall ABT-rate compared to no-PC-patients (35% vs. 40%, p = 0.619), but a trend towards reduced transfusion requirement (>2 ABT-units: 9% vs. 21%, p = 0.052; >4 ABT-units: 2% vs. 11%, p = 0.037) and better survival (OS: 78 vs. 44 months, p = 0.088; RFS: 36 vs. 24 months; p = 0.029). Favorable long-term outcomes and lower rates of increased transfusion demand were observed in patients with PC undergoing resection for CRLM. Further prospective evaluation of potential oncologic benefits of PC in these patients may be meaningful.
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Affiliation(s)
- Tobias S. Schiergens
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Moritz Drefs
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Maximilian Dörsch
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Florian Kühn
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Markus Albertsmeier
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Hanno Niess
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Markus B. Schoenberg
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Matthias Assenmacher
- Department of Statistics, Ludwig-Maximilians-University Munich, Akademiestr 1, D-80799 Munich, Germany; (M.A.); (H.K.)
| | - Helmut Küchenhoff
- Department of Statistics, Ludwig-Maximilians-University Munich, Akademiestr 1, D-80799 Munich, Germany; (M.A.); (H.K.)
| | - Wolfgang E. Thasler
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Markus O. Guba
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Martin K. Angele
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Markus Rentsch
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Jens Werner
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
| | - Joachim Andrassy
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistr 15, D-81377 Munich, Germany; (M.D.); (M.D.); (F.K.); (M.A.); (H.N.); (M.B.S.); (W.E.T.); (M.O.G.); (M.K.A.); (M.R.); (J.W.); (J.A.)
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Warsinggih, Liliyanto, Marhamah, Kusuma MI, Uwuratuw JA, Syarifuddin E, Faruk M. Relationship between BRAF V600E and KRAS mutations in stool for identifying colorectal cancer: A cross-sectional study. Ann Med Surg (Lond) 2020; 60:121-125. [PMID: 33145020 PMCID: PMC7593265 DOI: 10.1016/j.amsu.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/11/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background With early diagnosis, colorectal cancer (CRC) is a curable disease. As studies in the past 15 years have shown, specific genetic changes occur in the neoplastic transformation of normal colonic epithelium to benign adenoma until becoming adenocarcinoma. Considering that dynamic, we aimed to determine how v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E and Kirsten rat sarcoma (KRAS) mutations relate to the location, histopathology, and degree of tumor differentiation in CRC. Methods With a cross-sectional design involving an observational analytical approach, we determined the relationship of BRAF V600E and KRAS mutations to the location, histopathology, and degree of tumor differentiation in CRC. Result The sample contained 43 patients with CRC aged 21-80 years, with an average age of 56.0 ± 11.2 years, 46.5% of whom were male and 53.5% female, for a male-to-female ratio of 1.0-1.15. Most tumors were located in the right colon (n = 18, 41.9%), followed by the rectum (n = 14, 32.6%) and left colon (n = 18, 25.6%). Non-mucinous adenocarcinoma was more prevalent than mucinous adenocarcinoma, with 22 (51.2%) and 21 (48.8%) patients, respectively. Nineteen tumors were poorly differentiated (44.2%), 15 were moderately differentiated (34.9%), and nine were well-differentiated (20.9%). BRAF V600E mutations totaled six (14%), whereas non-BRAF V600E mutations totaled 37 (86.0%). BRAF V600E mutations significantly related to tumor location, degree of differentiation, and histopathology (p < .01). Conclusion A significant relationship exists between BRAF V600E mutations in the stool of patients with CRC and location, histopathology, and degree of tumor differentiation.
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Affiliation(s)
- Warsinggih
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Liliyanto
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Marhamah
- Department of Pediatric Dentistry, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia
| | - M Ihwan Kusuma
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Julianus Aboyaman Uwuratuw
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Erwin Syarifuddin
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Yoshida N, Naito Y, Inada Y, Itoh Y, Lee SP, Kim JH, Sung IK, Park HS, Han HS, Nakanishi M, Kishimoto M, Lee SY. Cross-national analysis about the difference of histopathological management in Tis and T1 colorectal cancer between Japan and Korea. J Anus Rectum Colon 2019; 3:18-26. [PMID: 31559363 PMCID: PMC6752126 DOI: 10.23922/jarc.2017-031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/31/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES There are differences in each country with regards to histopathological managements of colorectal cancer (CRC), such as definition of Tis and lymphatic and venous invasion. In this study, we compared Tis and T1 CRC in Japan and Korea. METHODS We retrospectively compared various clinical characteristics of consecutive patients who had Tis and T1 CRCs and who were newly diagnosed between 2010 and 2014 at the Kyoto Prefectural University of Medicine (Japan) and the Konkuk University (Korea). RESULTS Three hundred and sixty-five cases of T1 cancer and 510 cases of Tis cancer from 726 Japanese and 149 Korean patients were included. The rate of Tis in Japan was higher than in Korea (59.8% vs. 51.0%, P = 0.047), according to the difference of definition of Tis. In the analyses of 365 T1 CRCs, median age was higher in Japan than Korea (67.8 ± 10.6 vs. 62.2 ± 10.1, P < 0.001). Right-sided lesions were more frequent in Japan than they were in Korea (38.7% vs. 22.2%, P < 0.001). The rates of venous and lymphatic invasion were higher in Japan than they were in Korea (venous: 18.6% vs. 1.4%, P < 0.001, lymphatic: 25.3% vs. 13.7%, P = 0.042), according to the different methods of immunohistochemical examinations used (Japan: E-HE and D2-40, Korea: ERG). CONCLUSIONS Our study of T1 CRC showed that there were differences between Japan and Korea in tumor location, elderly incidence, and histopathological lymphatic and venous invasion. Additionally, rates of Tis were different between the two countries. In this international study for CRC, it is considered that we have to pay attention regarding the difference of histopathological definition and method in each country.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sang Pyo Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Masayoshi Nakanishi
- Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Senore C, Bellisario C, Segnan N. Distribution of colorectal polyps: Implications for screening. Best Pract Res Clin Gastroenterol 2017; 31:481-488. [PMID: 28842058 DOI: 10.1016/j.bpg.2017.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the last decades data from different studies reported modifications of the topographic distribution of colorectal cancers (CRCs), with an increased frequency of tumours in proximal colonic segments. Given the documented link between adenomas and CRC, a proximal migration of adenomas over time could be expected as well. AIM To evaluate available evidence about the prevalence of adenomas and of sessile serrated polyps across colonic segments, the changing trends in their distribution across the colon and the diagnostic performance of screening tests currently adopted in population based screening programs for lesions located in different colonic segments. METHODS Literature search on PubMed, Embase, and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects with reference to preferred reporting items for systematic reviews and meta-analysis (PRISMA), considering all adult human studies in English, published between January 2000 and February 2017. RESULTS Cross-sectional analysis of endoscopy and pathology data-bases are consistently showing a trend toward an increase with age of the proportion of adenomas located in the proximal colon. Several observational studies analysed the site distribution of adenomas, testing the hypothesis of a proximal shift of these lesions, and most of them reported an increase in the proportion of right-sided adenomas over time, although a similar trend was not confirmed by others. Also the quality of the retrieved evidence was low. Both endoscopy and FIT are showing a different level of sensitivity for lesions arising in different colonic segments, depending also on screenees characteristics. CONCLUSION Available evidence is supporting the hypothesis of an increase in the proportion of right-sided adenomas with age, while a similar increase has not been reported for SSP/A, at least among subjects aged 50 or older. The trend toward a proximalization of colorectal adenomas over time, reported by some authors, likely results from improved diagnostic performances and/or the process of population ageing.
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Affiliation(s)
- Carlo Senore
- AOU Città della Salute e della Scienza, SC Epidemiologia, screening, registro tumori - CPO, Turin, Italy.
| | - Cristina Bellisario
- AOU Città della Salute e della Scienza, SC Epidemiologia, screening, registro tumori - CPO, Turin, Italy
| | - Nereo Segnan
- AOU Città della Salute e della Scienza, SC Epidemiologia, screening, registro tumori - CPO, Turin, Italy
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Magrath M, Yang E, Singal AG. Personalizing Colon Cancer Screening: Role of Age and Comorbid Conditions. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Richter J, Rudeck S, Kretz AL, Kramer K, Just S, Henne-Bruns D, Hillenbrand A, Leithäuser F, Lemke J, Knippschild U. Decreased CK1δ expression predicts prolonged survival in colorectal cancer patients. Tumour Biol 2016; 37:8731-9. [PMID: 26738869 DOI: 10.1007/s13277-015-4745-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/27/2015] [Indexed: 01/08/2023] Open
Abstract
Cancers arising from the large intestine or rectum are called colorectal cancer (CRC) and represent the fourth leading cause of cancer-related death worldwide. Since casein kinase 1 (CK1) isoforms are involved in many cellular processes and have been reported to be deregulated in various tumor entities, CK1 has become an interesting drug target. In this study, we examined the potential of CK1δ expression levels in tumor tissue of CRC patients as a prognostic biomarker. We show by quantitative RNA expression analyses that decreased CK1δ expression levels in tumor tissue predict prolonged survival rates. Random sampling of CK1δ stained tumor tissue indicates that CK1δ gene expression corresponds with CK1δ protein expression. Especially in low grade (grade 1, grade 2) and in UICC II/III classified tumors decreased CK1δ RNA levels correlate with significantly improved survival rates when the tumor was located in the right colon. We furthermore found gender-specific differences within these subgroups, revealing most significant increase in overall survival rates in male patients with tumors in right colon expressing low levels of CK1δ RNA. Results become even clearer, when only male patients over 50 years were considered. Together, these findings support the assumption that CK1δ might be a prognostic biomarker for CRC thereby providing an interesting drug target for the development of new therapy concepts.
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Affiliation(s)
- Julia Richter
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Steven Rudeck
- Department of Internal Medicine II, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Anna-Laura Kretz
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Klaus Kramer
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Steffen Just
- Department of Internal Medicine II, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Frank Leithäuser
- Department of Pathology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Johannes Lemke
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Uwe Knippschild
- Department of General and Visceral Surgery, Surgery Centre, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Schmidt T, Strowitzki MJ, Reissfelder C, Rahbari NN, Nienhueser H, Bruckner T, Rahäuser C, Keppler U, Schneider M, Büchler MW, Ulrich A. Influence of age on resection of colorectal liver metastases. J Surg Oncol 2015; 111:729-39. [DOI: 10.1002/jso.23872] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/22/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Thomas Schmidt
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Moritz J. Strowitzki
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Christoph Reissfelder
- Department of Visceral; Thoracic and Vascular Surgery; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - Nuh N. Rahbari
- Department of Visceral; Thoracic and Vascular Surgery; University Hospital Carl Gustav Carus; Technical University Dresden; Dresden Germany
| | - Henrik Nienhueser
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Thomas Bruckner
- Department of Medical Biometry; University of Heidelberg; Heidelberg Germany
| | - Christoph Rahäuser
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Ulrich Keppler
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Martin Schneider
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Markus W. Büchler
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
| | - Alexis Ulrich
- Department of General; Visceral and Transplant Surgery; University of Heidelberg; Heidelberg Germany
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Impact of perioperative allogeneic red blood cell transfusion on recurrence and overall survival after resection of colorectal liver metastases. Dis Colon Rectum 2015; 58:74-82. [PMID: 25489697 DOI: 10.1097/dcr.0000000000000233] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative allogeneic red blood cell transfusion has been conclusively shown to be associated with adverse oncologic outcomes after resection of nonmetastatic colorectal adenocarcinoma. OBJECTIVE The aim of the study was to identify risk factors for a perioperative transfusion and to assess the effects of transfusion on survival after curative-intended resection of hepatic metastases in patients featuring stage IV colorectal cancer. DESIGN This was an observational study with a retrospective analysis of a prospective data collection. SETTING The study was conducted at a tertiary care center. PATIENTS A total of 292 patients undergoing curative-intended liver resection for colorectal liver metastases were included in the study. MAIN OUTCOME MEASURES Univariate and multivariate analyses were performed identifying factors influencing transfusion, recurrence-free survival, and overall survival. RESULTS A total of 106 patients (36%) received allogeneic red blood cells. Female sex (p = 0.00004), preoperative anemia (p = 0.001), major intraoperative blood loss (p < 0.00001), and major postoperative complications (p = 0.02) were independently associated with the necessity of transfusion. Median recurrence-free and overall survival were 58 months. Allogeneic red blood cell transfusion was significantly associated with reduced recurrence-free survival (32 vs 72 months; p = 0.008). It was reduced further by administration of >2 units (27 months; p = 0.02). Overall survival was not significantly influenced by transfusion (48 vs 63 months; p = 0.08). When multivariately adjusted for major intraoperative blood loss and factors univariately associated, namely comorbidities, tumor load, and positive resection margins, transfusion was an independent predictor for reduced recurrence-free survival (p = 0.03). LIMITATIONS These include the retrospective and observational design, as well as the impossibility to prove causality of the association between transfusion and poor outcome. CONCLUSIONS In patients undergoing liver resection for colorectal liver metastases, perioperative transfusion is independently associated with earlier disease recurrence. This emphasizes appropriate blood management measures, including the conservative correction of preoperative anemia, the use of low transfusion triggers, and the minimization of intraoperative blood loss.
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Park SH, Song CW, Kim YB, Kim YS, Chun HR, Lee JH, Seol WJ, Yoon HS, Lee MK, Lee JH, Bhang CS, Park JH, Park JY, Do BH, Park YD, Yoon SJ, Park CW, Yoon SM, Choi JH, Shin KC, Ko DH, Kim YJ, Seol DC. Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions. Intest Res 2014; 12:131-8. [PMID: 25349580 PMCID: PMC4204700 DOI: 10.5217/ir.2014.12.2.131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study was to evaluate the clinicopathologic characteristics of colon cancers detected at the SOK Sokpeynhan Internal Medical Network, a nationwide system of primary health care institutions. METHODS We analyzed 579 colon cancer patients diagnosed using colonoscopy at the SOK network from January 2011 through December 2012. Cancers from the rectum to the splenic flexure were classified as left colon cancer. Patients over 65 were classified as senior. RESULTS The mean age (±SD) of subjects was 60.9±10.5 years and 61.1% were men. More than one quarter (28.2%) of patients were asymptomatic. The prevalence of left colon cancer was higher (77.9%) than that for right colon cancer. The most frequent macroscopic and histologic types were depressed (58.9%) and moderately differentiated adenocarcinoma (52.2%), respectively. Asymptomatic subjects displayed protruding or well differentiated adenocarcinoma, while symptomatic patients were more likely to display depressed or moderately differentiated adenocarcinoma (P<0.05). The mean age of the right colon cancer group was higher than that for the left colon cancer group (P<0.05). Among symptomatic patients, the most frequent symptoms were bloody stool for patients with left colon cancer and abdominal discomfort for patients with right colon cancer (P<0.05). The prevalence of depressed cancer was higher in older subjects as compared to younger subjects (P<0.05). The prevalence of right colon cancer tended to increase with age, although this difference did not achieve statistical significance (P>0.05). CONCLUSIONS Study results indicated an increase of colon cancer amongst younger demographics in recent years. The effectiveness of colonoscopy screening was also evident, as asymptomatic patients demonstrated frequent findings of well differentiated adenocarcinomas. Study results also suggested a need for closer examination of older patients, as right colon cancer tended to increase with age.
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Affiliation(s)
| | - Chi Wook Song
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | - Yun Bae Kim
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | - Young Sun Kim
- SOK Sokpeynhan Internal Medical Network, Seoul, Korea
| | | | - Jung Hyun Lee
- SOK Sokpeynhan Internal Medical Network, Busan, Korea
| | - Won Jong Seol
- SOK Sokpeynhan Internal Medical Network, Incheon, Korea
| | - Hyung Sun Yoon
- SOK Sokpeynhan Internal Medical Network, Incheon Gyeyang, Korea
| | | | - Jong Hyup Lee
- SOK Sokpeynhan Internal Medical Network, Deagu Sangin, Korea
| | | | | | - Ji Young Park
- SOK Sokpeynhan Internal Medical Network, Cheonan, Korea
| | - Byung Hun Do
- SOK Sokpeynhan Internal Medical Network, Pohang, Korea
| | | | - Sang Jeong Yoon
- SOK Sokpeynhan Internal Medical Network, Daejeon Dunsan, Korea
| | - Chan Wook Park
- SOK Sokpeynhan Internal Medical Network, Seodaejeon, Korea
| | - Su Mi Yoon
- SOK Sokpeynhan Internal Medical Network, Anyang, Korea
| | - Jong Hwan Choi
- SOK Sokpeynhan Internal Medical Network, Uijeongbu, Korea
| | - Ki Chul Shin
- SOK Sokpeynhan Internal Medical Network, Pyeongtaek, Korea
| | - Dong Hoon Ko
- SOK Sokpeynhan Internal Medical Network, Seongnam, Korea
| | - Young Jin Kim
- SOK Sokpeynhan Internal Medical Network, Ilsan, Korea
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Abstract
BACKGROUND Although the Centers for Medicare and Medicaid Services (CMS) denied coverage for screening computed tomography colonography (CTC) in March 2009, little is understood about whether CTC was targeted to the appropriate patient population prior to this decision. OBJECTIVE Evaluate patient characteristics and known relative clinical indications for screening CTC among patients who received CTC compared to optical colonoscopy (OC). DESIGN/PARTICIPANTS Cross-sectional study of all 10,538 asymptomatic Medicare beneficiaries who underwent CTC between January 2007 and December 2008, compared to a cohort of 160,113 asymptomatic beneficiaries who underwent OC, matched on county of residence and year of examination. MAIN MEASURES Patient characteristics and known relative appropriate and inappropriate clinical indications for screening CTC. KEY RESULTS CTC utilization was higher among women, patients > 65 years of age, white patients, and those with household income > 75 % (p = 0.001). Patients with relatively appropriate clinical indications for screening CTC were more likely to undergo CTC than OC including presumed incomplete OC (OR 80.7, 95 % CI 76.01-85.63); sedation risk (OR 1.11, 95 % CI 1.05-1.17); and chronic anticoagulation risk (OR 1.46, 95 % CI 1.38-1.54), after adjusting for patient characteristics and known clinical indications. Conversely, patients undergoing high-risk screening, an inappropriate indication, were less likely to receive CTC (OR 0.4, 95 % CI 0.37-0.42). Overall, 83 % of asymptomatic patients referred to CTC had at least one clinical indication relatively appropriate for CTC (8,772/10,538). CONCLUSION During the 2 years preceding CMS denial for screening, CTC was targeted to asymptomatic patients with relatively appropriate clinical indications for CTC/not receiving OC. However, CTC utilization was lower among certain demographic groups, including minority patients. These findings raise the possibility that future coverage of screening CTC might exacerbate disparities in colorectal cancer screening while increasing overall screening rates.
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Jafri NS, Gould M, El-Serag HB, Duan Z, Davila JA. Incidence and survival of colorectal cancer among Hispanics in the United States: a population-based study. Dig Dis Sci 2013; 58:2052-60. [PMID: 23086126 DOI: 10.1007/s10620-012-2454-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/04/2012] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hispanics are the largest and fastest growing ethnic group in the United States (US). AIMS We evaluated the incidence and survival of colorectal cancer (CRC) among this population. METHODS Data from the surveillance, epidemiology, and end results program were used to calculate CRC age-adjusted and age-specific incidence rates in Hispanics during 1993-2007. Temporal trends in CRC incidence were examined using annual percent change (APC) and Poisson regression. The 1- and 5-year survival rates were calculated. RESULTS The annual age-adjusted incidence rates for CRC in Hispanics of all ages declined from 47.4 per 100,000 in 1993-1997 to 43.8 per 100,000 in 2003-2007, with an APC during 1993-2007 equal to -0.8/year. However, there was a 45 % increase in CRC incidence among Hispanic men and women aged 20-49 years that affected both the right and left colon. The proportions of CRC cases with regional (+37 %) and distant (+18 %) spread increased, now constituting 72 % of cases diagnosed at that age. The Poisson model confirmed the increasing CRC incidence in Hispanics aged 20-49 years during 1993-2007 while adjusting for sex and geographic region. The 1-year survival improved in younger Hispanics from approximately 86 % in 1993-1997 to 91 % in 2003-2007 with no significant improvement in 5-year survival. In Hispanics aged >50 years, no significant improvements in survival were observed. CONCLUSIONS The incidence of CRC in young Hispanic men and women has increased in the US. Most are diagnosed with regional or distant disease. No significant improvement in long-term survival was observed in young Hispanics with CRC.
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Affiliation(s)
- Nadim S Jafri
- Section of Gastroenterology, The Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
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12
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Di Benedetto F, Berretta M, D'Amico G, Montalti R, De Ruvo N, Cautero N, Guerrini GP, Ballarin R, Spaggiari M, Tarantino G, Di Sandro S, Pecchi A, Luppi G, Gerunda GE. Liver resection for colorectal metastases in older adults: a paired matched analysis. J Am Geriatr Soc 2012; 59:2282-90. [PMID: 22188075 DOI: 10.1111/j.1532-5415.2011.03734.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the safety and long-term results of hepatic resection of colorectal liver metastases (CLM) in older adults. DESIGN Case-control. SETTING Single liver and multivisceral transplant center. PARTICIPANTS Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing. MEASUREMENTS Postoperative complications and survival rates. RESULTS There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups (P = .10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group (P = .72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group (P = .50). CONCLUSIONS Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible.
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Affiliation(s)
- Fabrizio Di Benedetto
- Liver and Multivisceral Transplant Center, Hepatopancreatic and Biliary Surgery, University of Modena and Reggio Emilia, Modena, Italy.
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13
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Yoshida D, Ikeda Y, Waki K, Shirabe K, Kakeji Y, Tsujitani S, Maehara Y. Different incidence of synchronous liver metastasis between proximal and distal colon cancer. Surg Today 2011; 42:426-30. [DOI: 10.1007/s00595-011-0056-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 04/13/2011] [Indexed: 12/13/2022]
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Shaukat A, Virnig DJ, Salfiti NI, Howard DH, Sitaraman SV, Liff JM. Is inflammatory bowel disease an important risk factor among older persons with colorectal cancer in the United States? A population-based case-control study. Dig Dis Sci 2011; 56:2378-83. [PMID: 21409378 DOI: 10.1007/s10620-011-1632-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 02/14/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND While ulcerative colitis (UC) and Crohn's disease (CD) are thought to predispose to colorectal cancer (CRC), the association has not been well studied in an older population. AIMS The objective of our study was to evaluate the association of ulcerative colitis and Crohn's disease and colorectal cancer in a population-based, case-control study. We also wished to estimate the incidence rates of colorectal cancer among older individuals with UC/CD. METHODS All cases of colorectal cancer in persons 67 and older in the SEER catchment area and in the Medicare claims database were compared with cancer-free controls residing in the same geographic area. We used multivariable logistic regression models adjusted for demographic and other factors. RESULTS We identified 47,543 cases of CRC and 142,273 controls. We found a modest association between UC and CRC (OR 1.93; 95% CI 1.54-2.49; P-value<0.001) and a significant, albeit modest, association between CD and CRC (OR 1.45; 95% CI 1.08-1.91; P-value 0.01). We found the incidence of CRC to be 8.2 per 10,000 person-years (95% CI 6.5-10.1/10,000 person-years) among those with UC/CD, and 6.1 per 10,000 person-years (95% CI 4.6-7.8/10,000 person-years) among those without UC/CD, resulting in an incidence rate ratio of 1.34. CONCLUSIONS Among older persons ulcerative colitis and Crohn's disease are modest risk factors for CRC, and the incidence rate ratio for CRC is modest, suggesting that risk of CRC in patients with IBD may be lower than previously thought.
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Affiliation(s)
- Aasma Shaukat
- Section of Gastroenterology, Department of Medicine, VA Medical Center and University of Minnesota, Gastroenterology Section 111-D, 1- Veterans Drive, Minneapolis, MN 55417, USA.
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15
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Uraoka T, Higashi R, Kato J, Kaji E, Suzuki H, Ishikawa S, Akita M, Hirakawa T, Saito S, Hori K, Kawahara Y, Mead RJ, Yamamoto K. Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age. Surg Endosc 2011; 25:3000-7. [PMID: 21484532 DOI: 10.1007/s00464-011-1660-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/20/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been used recently for successful en bloc resection of even large lesions, although no consensus appears in medical literature concerning its application to elderly patients. This prospective cohort study aimed to evaluate the efficacy and safety of colorectal ESD for patients 80 years of age or older. METHODS Colorectal ESD procedure findings were compared with clinical outcomes, including associated complications and mortalities, for two age groups totaling 196 consecutive patients with 202 colorectal lesions. Of the 196 patients, 31 patients (16%) were 80 years of age or older (group E), and 165 patients (84%) were younger than 80 years (group Y). RESULTS The median ages were 82 years in group E and 68 years in group Y. The frequency of chronic concomitant diseases was significantly higher in group E (65%) than in group Y (27%) (p = 0.003). No significant pressure decrease or need for oxygenation was observed in either group. In addition, groups E and Y did not differ significantly in terms of mean lesion sizes (40.9 vs. 39.7 mm) en bloc resection rates (84% vs. 93%), curative rates (78% vs. 84%), median procedure times (65 vs. 70 min), or associated complications (no perforation or delayed bleeding cases [0%] vs. 5 perforations [3%]) The median postprocedure hospitalization period was 3 days in both groups. Except for 10 cases requiring subsequent lymph node dissection surgery, follow-up colonoscopy examinations showed no recurrences or ESD-related mortalities in either group. CONCLUSION Colorectal ESD is a safe and effective treatment for elderly patients (age ≥ 80 years) despite a significantly higher frequency of chronic concomitant diseases than among younger patients.
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Affiliation(s)
- Toshio Uraoka
- Department of Endoscopy, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
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16
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Incidence of colorectal cancer in Kashmir valley, India. Indian J Gastroenterol 2011; 30:7-11. [PMID: 21318425 DOI: 10.1007/s12664-010-0071-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/04/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is wide variation in the incidence of colorectal cancer globally and also within the same country among different racial or ethnic groups. The present population-based study was undertaken to determine the incidence of colorectal cancer in Kashmiri population which is non-migratory and ethnically homogeneous having stable food habits. METHODS Over a period of one year, all newly diagnosed and histological proved cases of colorectal cancer in all possible areas, where such patients are diagnosed and treated were prospectively registered. RESULTS A total of 212 cases of colorectal cancers were registered; of them 113 (53.3%) originated in the colon and other 99 (46.7%) in rectum. Male to female ratio was 1.2:1. The crude incidence rate of colorectal cancer was 3.65/100,000; it was 3.78 in males, and 3.50/100,000 in females. The incidence rates for colorectal cancer in Muslims and Hindus were different. The crude incidence rate for colorectal carcinoma was highest for district Srinagar 6.19/100,000 (urban area) and lowest for district Kupwara (rural area) 1.59/100,000. The highest numbers of cases were detected in the age group 55-59 years (n = 34). The age-specific rate for colorectal carcinoma was highest in the age group 55-59 years (17.21/100,000), followed by 65-69 years (14.86/100,000). The age standardized incidence rate was 4.52/100,000 per year. The truncated age adjusted incidence rates in age group 35-64 years was 8.31/100,000; while that for colorectal carcinoma was 8.77/100,000 in males and 7.66/100,000 in females. CONCLUSION We conclude that the incidence of colorectal cancer in Kashmir valley is similar to that reported in the rest of India.
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Abstract
BACKGROUND Colon cancer is the third leading cause of death from cancer in the United States. Recent studies report on increasing proportions of proximal cancers. The etiology behind this epidemiological trend is unclear, and its implication on survival outcomes is unknown. Further analysis of the impact of anatomic site of disease among a large multiethnic population will help facilitate research and education to improve colon cancer screening and treatment. OBJECTIVE To investigate the association between proximal tumor location and survival in patients with colon cancer. DESIGN AND PARTICIPANTS A large retrospective cohort study in the US utilizing the Surveillance, Epidemiology, and End Results (SEER) cancer registry analyzed survival outcomes of patients with colon cancer. Multivariable logistic regression analyses investigated sex-specific, race/ethnicity-specific, and anatomic site-specific disparities in survival. MAIN MEASURES Five-year survival outcomes from colon cancer. RESULTS Our study demonstrated significant disparities in survival by sex, race/ethnicity, and anatomic site. Across all time periods and among most cohorts, patients with proximal cancers had significantly worse survival outcomes. When compared to distal cancers, patients with proximal cancers were 13% less likely to survive 5 years (OR 0.87; 95% CI, 0.82-0.91). When compared to non-Hispanic whites, blacks were 30% less likely to survive 5 years (OR 0.70; 95% CI, 0.68-0.73). Stage-specific multivariable regression analysis of localized cancers demonstrated similar findings. CONCLUSIONS Significant race-specific, sex-specific, and anatomic site-specific disparities in colon cancer survival exist. Proximal cancers are associated with worse survival odds. These disparities may reflect differences in the genotype and phenotype of colon cancer among these groups. A modified risk assessment tool that incorporates these variations may be more effective in the early detection and treatment of colon cancer.
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18
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Abstract
GOALS To investigate the race/ethnicity and sex-specific variations in proximal colon cancer survival within the United States. BACKGROUND Recent studies suggest a shift toward more proximal distributions of colon cancers. Survival benefits from screening colonoscopy may be limited to left-sided cancers. Identifying groups at greatest risk for mortality from proximal cancers will help to target health care resources to address these disparities. STUDY A retrospective cohort study from 1973 to 2004 using a large population-based cancer registry to investigate demographic variations in colon cancer survival. RESULTS Marked sex and race/ethnicity-specific variations in proximal colon cancer survival were observed. Overall 5-year survival was greatest in females (5-y survival, females: 44.5% and males: 41.7%, P<0.001) and in Asians (5-y survival, Asians: 50.4%, non-Hispanic whites: 43.1%, blacks: 39.7%, and Hispanics: 46.7%, P<0.001). Compared with females, males had significantly worse 5-year survival outcomes [odds ratios (OR), 0.77; 95% confidence intervals (CI), 0.75-0.79]. Compared with non-Hispanic whites, blacks had worse 5-year survival odds (OR, 0.74; 95% CI, 0.70-0.78) and Asians had better survival outcomes (OR, 1.16; 95% CI, 1.08-1.24). CONCLUSIONS There exists significant sex and race/ethnicity-specific disparities in 5-year survival from proximal colon cancer. These differences may be explained by variations in delivery of health care between demographic groups or differences in disease biology specific to each group.
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Kim JY, Jang ES, Park SY, Park JH, Yoon H, Park YS, Kim N, Lee DH, Jung HC, Song IS. Distinct Characteristics of Colorectal Cancer and Frequency of Right Colon Cancer in Elderly Patients of Korea. ACTA ACUST UNITED AC 2010. [DOI: 10.4235/jkgs.2010.14.3.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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20
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Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ. Liver resection of colorectal metastases in elderly patients. Br J Surg 2010; 97:366-76. [DOI: 10.1002/bjs.6889] [Citation(s) in RCA: 184] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
This study evaluated the outcome of liver surgery for colorectal metastases (CLM) in patients over 70 years old in a large international multicentre cohort.
Methods
Among 7764 patients who had resection of CLM, 999 (12·9 per cent) were aged 70–75 years, 468 (6·0 per cent) were aged 75–80 years and 157 (2·0 per cent) were at least 80 years old. Elderly patients were compared with the younger population.
Results
Multinodular and bilateral metastases were less common in elderly than in younger patients (P < 0·001). Preoperative chemotherapy was used less frequently and more limited surgery was performed (P < 0·001). Sixty-day postoperative mortality and morbidity rates were 3·8 and 32·3 per cent respectively, compared with 1·6 and 28·7 per cent in younger patients (both P < 0·001). Three-year overall survival was 57·1 per cent in elderly and 60·2 per cent in younger patients (P < 0·001), and was similar among patients aged 70–75, 75–80 or at least 80 years (57·8, 55·3 and 54·1 per cent respectively; P = 0·160). Independent predictors of survival were more than three metastases, bilateral metastases, concomitant extrahepatic disease and no postoperative chemotherapy.
Conclusion
Liver resection for CLM in elderly patients can achieve a reasonable 3-year survival rate, with an acceptable morbidity rate. There should be no upper age limit but risk factors may help predict potential benefit.
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Affiliation(s)
- R Adam
- Hepatobiliary Centre, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, University Paris-Sud, Unité Mixte de Recherche S 776, France
| | - A Frilling
- Department of Surgery, Essen University Hospital, Essen, Germany
| | - D Elias
- Department of Surgery, Institute Gustave Roussy, Villejuif, France
| | - C Laurent
- Department of Surgery, Hôpital Saint André, Bordeaux, France
| | - E Ramos
- Department of Surgery, University Hospital Bellvitge, Barcelona, and Hospital de Girona, Girona, Spain
| | - L Capussotti
- Department of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy
| | - G J Poston
- Department of Surgery, University Hospital Aintree, Liverpool, UK
| | - D A Wicherts
- Hepatobiliary Centre, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, University Paris-Sud, Unité Mixte de Recherche S 776, France
| | - R J de Haas
- Hepatobiliary Centre, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse, University Paris-Sud, Unité Mixte de Recherche S 776, France
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Hendifar A, Yang D, Lenz F, Lurje G, Pohl A, Lenz C, Ning Y, Zhang W, Lenz HJ. Gender disparities in metastatic colorectal cancer survival. Clin Cancer Res 2009; 15:6391-7. [PMID: 19789331 DOI: 10.1158/1078-0432.ccr-09-0877] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Previous studies have shown that estrogen prevents colon cancer in postmenopausal women, indicating a role in colorectal cancer carcinogenesis and tumor progression. We investigated the interactions between sex, age, ethnicity, and year of diagnosis on overall survival (OS) in patients with metastatic colorectal cancer (MCRC). EXPERIMENTAL DESIGN We screened 52,882 patients with MCRC from 1988 to 2004, using the Surveillance Epidemiology and End Results registry. Age at diagnosis, sex, ethnicity, tumor location, year of diagnosis, OS, and cancer-specific survival were evaluated using Cox proportional hazards model. The models were adjusted for marital status, tumor site, tumor differentiation, and treatment with radiation and/or surgery. RESULTS We observed that younger women (18-44 years old) with MCRC lived longer than younger men (17 months versus 14; P < 0.0001, log-rank test). In contrast, older women (55 years and older) had significantly worse OS than older men (7 months versus 9; P < 0.0001, log-rank test). In multivariate analysis, we found that gender discrepancies have widened in recent years; young women diagnosed after 2000 have improved cancer-specific survival, compared to men (hazard ratio, 0.778; 95% confidence interval, 0.669-0.904), but those diagnosed before 2000 benefit less (hazard ratio, 0.931; 95% confidence interval, 0.821-1.056). CONCLUSION As one of the largest data sets analyzed to establish that younger women with MCRC survive longer than younger men, hormonal status not only seems to play an important role in the development and pathogenesis of colorectal cancer but also may be of prognostic significance. These data warrant further studies to determine the role of estrogen in colorectal cancer.
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Affiliation(s)
- Andrew Hendifar
- Division of Medical Oncology and Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033, USA
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Wong RJ. Marked Variations in Colon Cancer Epidemiology: Sex-specific and Race/Ethnicity-specific Disparities. Gastroenterology Res 2009; 2:268-276. [PMID: 27956970 PMCID: PMC5139773 DOI: 10.4021/gr2009.09.1311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2009] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Recent studies have reported on the changing epidemiology of colon cancer. Given this cancer's high prevalence and mortality, defining high risk groups will be important to guide improvements in cancer screening programs. METHODS A retrospective cohort study of a large population-based cancer registry in the United States from 1973-2004 was performed to analyze the race and sex-specific disparities in colon cancer epidemiology. RESULTS Blacks and females demonstrated the greatest proportions of proximal cancers: the incidence rate of proximal cancers among black males was more than double that of Asian males (25.2 per 100,000/year vs 11.7 per 100,000/year, p < 0.0001) and the rate among black females was twice that of Asian females (21.9 per 100,000/year vs 11.4 per 100,000/year, p < 0.0001). Blacks as a group had the highest rates of advanced cancers: the rate among black males was nearly double that of Hispanic males (17.1 per 100,000/year vs 8.7 per 100,000/year, p < 0.0001) and the rate of advanced cancers among black females was twice that of Hispanic females (12.4 per 100,000/year vs 6.2 per 100,000/year, p < 0.0001). CONCLUSIONS This study demonstrates marked disparities in the sex-specific and race/ethnicity-specific epidemiology of colon cancer. These differences likely represent unequal access to health care resources and race and sex-specific variations in cancer biology. An individualized approach incorporating these disparities would benefit future research and guidelines for improvements in cancer screening programs.
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Affiliation(s)
- Robert John Wong
- Department of Medicine, California Pacific Medical Center, 2351 Clay Street, Suite 380, San Francisco, CA USA 94115.
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Jensen SA, Lønborg JT, Sørensen JB. Benefits and risks of palliative capecitabine based therapy to elderly patients with advanced colorectal cancer: Danish single centre experiences. Acta Oncol 2009; 45:67-76. [PMID: 16464798 DOI: 10.1080/02841860500375213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to compare efficacy and toxicity of palliative chemotherapy for elderly and younger colorectal cancer patients. Patients aged 24-69 (n = 203) and 70-82 years (n = 57) with advanced colorectal cancer were consequetively treated with first line capecitabine monotherapy or combined with oxaliplatin (XELOX). The response rates were 37% and 33% (P = 0.61), the median times to progression were 5.5 and 6.0 months (P = 0.84, hazard ratio (HR) 1.09; 95% confidence interval: 0.71-1.68), and median overall survival times were 8.4 and 12.5 months (P = 0.07, HR 1.48; 1.04-2.38) for elderly and younger patients, respectively. Elderly patients had similar frequencies of Common Toxicity Criteria (CTC) grade 3 or 4 toxicity (P > 0.05) and number of treatment courses (P = 0.44), and maintained performance status as well as younger patients (P = 0.68). Palliative capecitabine based therapy for advanced colorectal cancer should be considered also for elderly who are in good performance without major comorbidities.
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Affiliation(s)
- Søren Astrup Jensen
- Department of Oncology, National University Hospital, 9 Blegdamsvej, Copenhagen, DK-2100, Denmark.
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Abstract
Although there are several methods available for colon cancer screening, none is optimal. This article reviews methods for screening, including fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, CT colonography, capsule endoscopy, and double contrast barium enema. A simple, inexpensive, noninvasive, and relatively sensitive screening test is needed to identify people at risk for developing advanced adenomas or colorectal cancer who would benefit from colonoscopy. It is hoped that new markers will be identified that perform better. Until then we fortunately have a variety of screening strategies that do work.
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Affiliation(s)
- Jack S Mandel
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 430, Atlanta, GA 30322, USA.
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Nawa T, Kato J, Kawamoto H, Okada H, Yamamoto H, Kohno H, Endo H, Shiratori Y. Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol 2008; 23:418-23. [PMID: 17532785 DOI: 10.1111/j.1440-1746.2007.04923.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Recently, the clinical and biological differences between right- and left-sided colon cancers have been widely debated. However, close analyses of these clinical differences, based on large-scale studies, have been scarcely reported. METHODS A total of 3552 consecutive Japanese colorectal cancer cases were examined and the clinical differences between right- and left-sided colon cancer cases were investigated. RESULTS The proportion of right-sided colon cancer was relatively high in patients aged less than 40 years (33%) and more than 80 years (43%). The proportion of right-sided colon cancer in patients aged 40-59 years was relatively low (male 22% and female 29%). In male patients the proportion increased in the 70-79 years age group (30%), while in female patients the proportion increased in the 60-69 years age group (39%). Right-sided colon cancer was more likely to be detected at an advanced stage (T1 stage; left 22%, right 15%) (P < 0.01) with severe symptoms. Polypoid-type early cancer was dominant in the left colon (left 59%; right 40%) (P < 0.01), while the proportion of flat-type early cancer in the right colon was significantly higher than that in the left colon (left 25%; right 44%) (P < 0.01). CONCLUSIONS Specific age distribution of right-sided colon cancer was observed and the difference between male and female patients was highlighted. Other clinical features also differed between right- and left-sided colon cancer, suggesting that different mechanisms may be at work during right and left colon carcinogenesis.
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Affiliation(s)
- Toru Nawa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Yamaji Y, Mitsushima T, Yoshida H, Watabe H, Okamoto M, Ikuma H, Wada R, Kawabe T, Omata M. Right-side shift of metachronous colorectal adenomas after polypectomy. Scand J Gastroenterol 2007; 42:1466-72. [PMID: 17852868 DOI: 10.1080/00365520701478543] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In our previous study, we showed that the development of adenomas in the right-side colon increased with aging in subjects with no colorectal neoplasms. The aim of the present study was to investigate the location of metachronous colorectal adenomas after endoscopic polypectomy. MATERIAL AND METHODS The records of a colonoscopic follow-up study on 2900 subjects after polypectomy were analyzed. The location was classified as the right-side colon and left-side colon at the splenic flexure. Subjects were classified into three groups according to distribution of adenomas at the initial two colonoscopies: those with adenomas located only in the left side (LL), adenomas in both the left side and right side (LR), and adenomas only in the right side (RR). Distribution of initial and metachronous adenomas was evaluated according to age. RESULTS The annual incidence rates of colorectal adenomas in the left-side colon were estimated to be 8.56%, 11.2%, and 5.71% in the LL, LR, and RR groups, respectively. The rates in the right side were 5.91%, 15.5%, and 9.38%, respectively. The incidence rates in the left side in the age groups <40, 40-49, 50-59, and > or =60 years were 6.93%, 8.08%, 8.33%, and 8.48%/year, respectively. Those in the right side were 4.91%, 7.27%, 9.86%, and 12.41%/year, respectively. CONCLUSIONS Although there may be individual predilection for right-side or left-side location of colorectal adenomas, aging tends to increase the number of adenomas in the right-side colon, while only modestly affecting those in the left-side colon.
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Affiliation(s)
- Yutaka Yamaji
- Department of Gastroenterology, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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Jensen SA, Vilmar A, Sørensen JB. Adjuvant chemotherapy in elderly patients (>or=75 yr) completely resected for colon cancer stage III compared to younger patients: toxicity and prognosis. Med Oncol 2007; 23:521-31. [PMID: 17303911 DOI: 10.1385/mo:23:4:521] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 11/30/1999] [Accepted: 03/28/2006] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare benefits and risks to adjuvant chemotherapy following complete resection of node-positive colon cancer stage III for patients aged >or=75 yr and younger. METHOD A retrospective study compared recurrence-free and overall survival, toxicity, and dose intensity of adjuvant bolus 5-FU according to the Mayo regimen chemotherapy in consecutive patients aged 19-74 (n=203) and >or=75 yr (n=24). RESULTS The estimated 5-yr proportional survival rates were 0.65 for patients age less than 75 yr compared to 0.65 (p=0.96) for elderly. The frequencies of anemia (0%), thrombocytopenia (0%), leukopenia (4%), infection (8%), vomiting (0%), mucositis (17%), diarrhea (13%) CTC grade 3 or 4 toxicity in elderly patients were not significantly different from that in younger patients (p > 0.05). Significantly more elderly (8%) had a decline in performance status to grade 3 or 4, as compared to younger patients (4%) (p=0.002). 5-FU dose reduction was necessary for significantly more elderly (51%) as compared to younger patients (28%) (p=0.02), and fewer elderly (54%) completed the scheduled six treatment courses as compared to younger patients (82%) (p=0.05). CONCLUSIONS Adjuvant 5-FU chemotherapy should be considered for elderly patients aged >or=75 yr in good performance at high risk of recurrence of colon carcinoma after resection.
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Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassini D, De Santis M, Colace L, Brozzetti S. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis 2007; 22:77-83. [PMID: 16538491 DOI: 10.1007/s00384-006-0096-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2005] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The liver is the most frequent site of liver metastases (LM) from colorectal cancer. Because of short life expectancies and improved nonoperative modalities, the role of liver resection in elderly patients with LM is unclear. METHODS During a 15-year period, 197 patients underwent liver resection for colorectal metastases. This study was designed to compare morbidity, mortality, and long-term outcome after hepatic resection in patients aged 70 years and older and in patients younger than 70. According to the age at the time of operation, patients were divided into two groups. Group A included patients aged 70 years or older and group B included younger patients. RESULTS The clinical and pathologic parameters of the two groups were compared and tested as factors affecting early and long-term outcomes after resection. A modified oncologic clinical risk score (CRS) was tested on this series of patients. Overall morbidity was 16.3% (group A 20.7% vs group B 14.6%; P=0.18). Hospital mortality was 3% (5.7% in group A and 2.1% in group B; P=0.19). Actuarial 5 years survival were 30% in group A and 38% in group B (P=ns). DISCUSSION The presence of more than three Fong's CRS parameters and microscopic involvement of resectional margin directly affected survival. Under meticulous preoperative assessment and postoperative care, liver resection for LM is justified in patients over 70 years of age; age by itself may not be a controindication to surgery.
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Affiliation(s)
- Gianluca Mazzoni
- Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Medical School, Viale del Policlinico, Rome, 00100, Italy.
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Yamaji Y, Mitsushima T, Yoshida H, Watabe H, Okamoto M, Wada R, Ikuma H, Kawabe T, Omata M. The Malignant Potential of Freshly Developed Colorectal Polyps According to Age. Cancer Epidemiol Biomarkers Prev 2006; 15:2418-21. [PMID: 17164364 DOI: 10.1158/1055-9965.epi-06-0136] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although malignant colorectal neoplasms are found more frequently in older population, polyps found at one-time colonoscopy may be a mixture of lesions that developed at various earlier ages. Newly developed adenomas found at the follow-up colonoscopies will reflect the exact relation between malignant potential and the age of development of colorectal polyps. METHODS The results of 44,065 follow-up colonoscopies on 11,912 subjects were analyzed. The proportion of invasive cancer or high-grade dysplasia among all neoplasms, "proportion of malignancy," was evaluated in relation to age groups (young: <50 years old; middle: 50-59 years old; and old: >or=60 years old). RESULTS At the follow-up colonoscopies, a total of 8,271 newly developed neoplasms were found, of which 41 (0.50%) lesions were malignant. The proportion of malignancy was 0.35%, 0.31%, and 1.07% in the young, middle, and old age groups, respectively (P(trend) = 0.002). This trend remained significant when stratified by the size of polyps. The proportion of malignancy was higher on the left-side colon than on the right-side colon, except in the old age group, where it was similar on either side. The proportion of malignancy at the follow-ups was not associated with the lesions found at the initial colonoscopies. CONCLUSIONS The development of malignant lesions in small sizes increased on the colon or rectum at older ages.
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Affiliation(s)
- Yutaka Yamaji
- Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Tokyo 113-8655, Japan.
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Affiliation(s)
- Gregory S Cooper
- Medicine Oncology and Epidemiology and Biostatistics Case Western Reserve University Cleveland, Ohio, USA
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Gutman SA, Merrick GS, Butler WM, Wallner KE, Allen ZA, Galbreath RW, Adamovich E. Temporal relationship between prostate brachytherapy and the diagnosis of colorectal cancer. Int J Radiat Oncol Biol Phys 2006; 66:48-55. [PMID: 16750312 DOI: 10.1016/j.ijrobp.2006.03.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 03/23/2006] [Accepted: 03/23/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify the location of pretreatment and posttreatment colorectal malignancies and posttreatment colorectal polyps in patients with clinically localized prostate cancer managed with brachytherapy. METHODS AND MATERIALS From April 1995 through July 2004, 1,351 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (American Joint Committee on Cancer, 2002) prostate cancer. Supplemental external beam radiotherapy (XRT) was administered to 699 patients. The median follow-up was 4.6 years. Operative and pathology reports were reviewed for all patients with pretreatment and posttreatment colorectal cancer and posttreatment colorectal polyps. Multiple parameters were evaluated for the development of colorectal cancer or colorectal polyps. RESULTS Colorectal cancer was diagnosed in 23 and 25 patients before and after prostate brachytherapy, respectively. No differences were identified in the distribution of colorectal cancers either before or after treatment (3 and 4 rectal cancers in the pre- and postbrachytherapy cohorts). Thirty-five of the 48 colorectal cancers (73%) were diagnosed within 5 years of brachytherapy with a peak incidence 1 year after brachytherapy. One hundred ninety-two colorectal polyps were diagnosed after brachytherapy, 160 (83%) occurred within 4 years of brachytherapy, and only 27 (14%) were located in the rectum. In multivariate Cox regression analysis, prostate D(90) (minimum percentage of the dose covering 90% of the target volume) predicted for posttreatment colorectal cancer. Rectal polyps were most closely related to patient age and percent positive biopsies, whereas sigmoid/colon polyps were best predicted by patient age, planning volume, and supplemental XRT. CONCLUSIONS Colorectal cancer was diagnosed with equal frequency before and after brachytherapy with comparable geographic distributions. In addition, the vast majority of postbrachytherapy colorectal polyps were located beyond the confines of the rectum.
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Affiliation(s)
- Sarah A Gutman
- Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV 26003, USA
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Duncan JE, Sweeney WB, Trudel JL, Madoff RD, Mellgren AF. Colonoscopy in the elderly: low risk, low yield in asymptomatic patients. Dis Colon Rectum 2006; 49:646-51. [PMID: 16482421 DOI: 10.1007/s10350-005-0306-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged 80 years and older to assess the risks and diagnostic yield in this population. METHODS We reviewed retrospectively the endoscopic and pathologic reports from consecutive colonoscopies performed on patients aged 80 years and older at a single, high-volume endoscopy center between August 1999 and May 2003. Patient characteristics, indications for examination, findings at colonoscopy, and complications were recorded and analyzed. RESULTS A total of1,199 colonoscopic examinations were performed on 1,112 patients. Average age was 83.1 (range, 80-100) years. Male:female distribution was 1:1.7. Leading exclusive indications for colonoscopy included: polyp surveillance, 227 (19 percent); altered bowel habits, 168 (14 percent); iron-deficiency anemia, 132 (11 percent); and cancer follow-up, 108 (9 percent). Eighty-six examinations (7 percent) were performed solely for an indication of colorectal cancer screening. Twenty-two percent of patients had more than one indication for colonoscopy. Forty-five malignancies were found (3.7 percent). No cancers were found in the screening group, and two malignancies (0.7 percent) were detected in patients undergoing colonoscopy for polyp surveillance. There were eight (0.6 percent) reported major complications. CONCLUSIONS Colonoscopy can be performed safely in patients aged 80 years and older. However, the diagnostic yield is low, particularly in patients undergoing routine screening or surveillance examinations. Colonoscopy should for the most part be limited to elderly patients with symptoms or specific clinical findings.
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Affiliation(s)
- James E Duncan
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 393 Dunlap Street North, Suite 500, St. Paul, Minnesota 55104, USA
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Wei JT, Sandler RS. The right test for colon cancer screening? Gastrointest Endosc 2006; 63:459-60. [PMID: 16500396 DOI: 10.1016/j.gie.2005.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Accepted: 10/04/2005] [Indexed: 12/10/2022]
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Yamaji Y, Mitsushima T, Ikuma H, Watabe H, Okamoto M, Yoshida H, Kawabe T, Wada R, Omata M. Right-side shift of colorectal adenomas with aging. Gastrointest Endosc 2006; 63:453-8; quiz 464. [PMID: 16500395 DOI: 10.1016/j.gie.2005.09.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 09/01/2005] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although it is known that right-side colon cancers increase with aging, the location of adenomas according to age has been controversial. Adenomas found at initial colonoscopies may be a mixture of polyps that arose at various earlier ages. OBJECTIVES To elucidate the relationship between location and age at which adenomas actually developed. DESIGN Prospective cohort study. SETTING A large-scale health appraisal institution in Japan. PATIENTS A total of 23,444 consecutive, asymptomatic Japanese who underwent total colonoscopy at their annual medical health check-up. INTERVENTIONS We analyzed newly developed adenomas after confirmation of the absence of colorectal neoplasms by two serial total colonoscopies. MAIN OUTCOME MEASUREMENTS The results of follow-up colonoscopies in 6304 subjects with no colorectal neoplasms at 2 initial colonoscopies were analyzed. The locations were separated into right-side colon and left-side colon from the splenic flexure. The locations of new adenomas found for the first time during the follow-up term were analyzed. RESULTS A total of 1472 subjects developed new colorectal adenomas. In 1255 cases with single adenomas, the ratios of number of cases with right-side lesions to that with left-side lesions at the ages of <40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and > or =70 years were 1.18, 1.00, 1.29, 1.31, and 1.89, respectively. In 217 cases with multiple adenomas found concurrently, the percentage of cases with adenomas only on the right side at the ages of <40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, and > or =70 years were 0%, 25%, 34%, 37%, and 63%, respectively. LIMITATIONS Small lesions might have been missed even by 2 serial colonoscopies. CONCLUSIONS Adenomas on the right-side colon increased with aging.
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Affiliation(s)
- Yutaka Yamaji
- Department of Gastroenterology, University of Tokyo, Japan
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Hill LB, O'Connell JB, Ko CY. Colorectal Cancer: Epidemiology and Health Services Research. Surg Oncol Clin N Am 2006; 15:21-37. [PMID: 16389148 DOI: 10.1016/j.soc.2005.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The causes of colorectal carcinoma are multifactorial. Numerous lines of epidemiologic evidence support the role of dietary factors, with strong associations revealed for folate and calcium, more equivocal evidence exists for dietary antioxidants. Lifestyle factors such as physical activity, alcohol in-take, and tobacco use are also positively correlated with the risk of colorectal carcinoma. Health services research examines epidemiologic issues,clinical evidence regarding prevention and treatment, patient preferences,and other factors with the goal of improving the quality of care. Observations based on epidemiologic studies and health services research will in the future provide the basis for reducing personal and social burdens caused by colorectal carcinoma.
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Affiliation(s)
- Letitia Bridges Hill
- Center for Surgical Outcomes and Quality, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, 72-215 CHS, Los Angeles, CA 90095, USA
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Yiu R, Qiu H, Lee SH, García-Aguilar J. Mechanisms of microsatellite instability in colorectal cancer patients in different age groups. Dis Colon Rectum 2005; 48:2061-9. [PMID: 16374936 DOI: 10.1007/s10350-005-0171-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The proportion of colorectal cancers located proximal to the splenic flexure increases with age. Colorectal cancers of the microsatellite instability phenotype are preferentially located in the proximal colon. We investigated the location of colorectal cancer with this phenotype in different age groups to determine whether different molecular mechanisms could account for the changes in distribution of colorectal cancers. METHODS A representative sample of 230 colorectal cancers from three age groups (<45 years, 60-70 years, >87 years) was selected from a subset of The Upper Midwest Oncology Medical Registries database. Microsatellite instability was determined by polymerase chain reaction using a panel of five microsatellite markers. The presence of new microsatellite alleles at two or more loci was scored as microsatellite instability. Tumors were otherwise considered microsatellite stable. MLH1 and MSH2 expression was determined by immunohistochemistry. Methylation of the MLH1 gene promotor was determined by methylation-specific polymerase chain reaction assay. RESULTS The proportion of tumors of the microsatellite instability phenotype was 21 percent in the young group, 15 percent in the middle group, and 33 percent in the old group. More tumors of the microsatellite instability phenotype were proximal compared with microsatellite-stable tumors in all three age groups, but the differences were significant only for the old group. Tumors of the microsatellite instability phenotype in the older group were associated with MLH1 inactivation (24/29 or 83 percent), MLH1 promoter methylation (18/29 or 62 percent), and proximal location (25/29 or 86 percent), while tumors in the young group were associated with MSH2 inactivation (8/18 or 44 percent) and distal location (11/18 or 62 percent). CONCLUSION The age-related proximal shift of colorectal cancers is associated with the microsatellite instability phenotype, MLH1 inactivation, and MLH1 promoter hypermethylation.
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Affiliation(s)
- Raymond Yiu
- Division of Colon and Rectal Surgery, University of Minnesota Cancer Center, Minneapolis, Minnesota, USA
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Walsh JME, Cheung AM, Yang D, Litwack S, Grady D. Raloxifene and colorectal cancer. J Womens Health (Larchmt) 2005; 14:299-305. [PMID: 15916502 DOI: 10.1089/jwh.2005.14.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To determine the effect of raloxifene on colorectal cancer (CRC) risk. METHODS We analyzed data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial, a randomized, blinded clinical trial designed to determine the effect of raloxifene on vertebral fracture risk. In this trial, 7705 women received either raloxifene or placebo and were followed for an average of 3.4 years. CRC cases were classified as definite (pathology available), probable (imaging or colonoscopic diagnosis), or possible (self-report). Relative hazard for CRC was calculated using multivariate Cox proportional hazards models. RESULTS Fifty cases of definite or probable CRC were diagnosed; 40 were definite and 10 probable. Twenty-nine cases occurred among the 5129 women in the raloxifene group, and 21 occurred among the 2576 women in the placebo group (p = 0.15). The relative hazard for CRC for women treated with raloxifene was 0.78 (95% CI 0.43, 1.43, p = 0.43). Restricting the analysis to definite CRC, the relative hazard was 0.77 (95% CI 0.39, 1.5, p = 0.45). CONCLUSIONS Although the MORE trial was large, the number of CRC cases was too small to provide definitive evidence concerning the effect of raloxifene on CRC risk. There does not appear to be a substantial increased risk of CRC with raloxifene use. Studies including larger numbers of women and women at risk for CRC should further investigate the effect of raloxifene on CRC.
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Affiliation(s)
- Judith M E Walsh
- Division of General Internal Medicine, University of California, San Francisco, USA.
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Amonkar MM, Hunt TL, Zhou Z, Jin X. Surveillance patterns and polyp recurrence following diagnosis and excision of colorectal polyps in a medicare population. Cancer Epidemiol Biomarkers Prev 2005; 14:417-21. [PMID: 15734967 DOI: 10.1158/1055-9965.epi-04-0342] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Study objectives were to determine surveillance and polyp recurrence rates among older, increased-risk patients who have been diagnosed and excised of colorectal polyps. The high incidence of colorectal cancers in the Medicare-eligible population, the strong evidence linking reductions in mortality from colorectal cancer by removal of colorectal polyps, and the paucity of postpolypectomy surveillance data in this population all supported the need for this study. METHODS This retrospective study used Medicare claims data to identify a cohort of 19,895 beneficiaries ages >/=65 years diagnosed and excised of colorectal polyps in 1994. Survival analysis was used to compute surveillance and polyp recurrence rates over 5 years. Log-rank test was used for all statistical comparisons. RESULTS Median time to first surveillance was 2.6 years. Surveillance rates for 1, 3, and 5 years were 17.6%, 55.8%, and 74.5%, respectively. Twenty-six percent had no surveillance event. Polyp recurrence rates for 1, 3, and 5 years were 10.9%, 38.2%, and 52.6%, respectively. Males and younger patients were more likely to undergo surveillance and showed higher polyp recurrence rates. CONCLUSIONS The high likelihood of polyp recurrence underscores the need for continued efforts to promote awareness of and compliance with postpolypectomy surveillance. Efforts to increase surveillance rates among individuals diagnosed with colorectal polyps and making available additional treatment options that may prevent the recurrence of polyps and/or their possible progression to colorectal cancer should help make significant progress in reaching the Healthy People 2010 goal of reducing colorectal cancer deaths by 34% by the year 2010.
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Affiliation(s)
- Mayur M Amonkar
- Worldwide Outcomes Research, Pfizer, Inc., 100 Route 206 North, Peapack, NJ 07977, USA
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Baxter NN, Tepper JE, Durham SB, Rothenberger DA, Virnig BA. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology 2005; 128:819-24. [PMID: 15825064 DOI: 10.1053/j.gastro.2004.12.038] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Radiation therapy for prostate cancer has been associated with an increased rate of pelvic malignancies, particularly bladder cancer. The association between radiation therapy and colorectal cancer has not been established. METHODS We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data from 1973 through 1994. We focused on men with prostate cancer, but with no previous history of colorectal cancer, treated with either surgery or radiation who survived at least 5 years. We evaluated the effect of radiation on development of cancer for 3 sites: definitely irradiated sites (rectum), potentially irradiated sites (rectosigmoid, sigmoid, and cecum), and nonirradiated sites (the rest of the colon). Using a proportional hazards model, we evaluated the effect of radiation on development of colorectal cancer over time. RESULTS A total of 30,552 men received radiation, and 55,263 underwent surgery only. Colorectal cancers developed in 1437 patients: 267 in irradiated sites, 686 in potentially irradiated sites, and 484 in nonirradiated sites. Radiation was independently associated with development of cancer over time in irradiated sites but not in the remainder of the colon. The adjusted hazards ratio for development of rectal cancer was 1.7 for the radiation group, compared with the surgery-only group (95% CI: 1.4-2.2). CONCLUSIONS We noted a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.
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Affiliation(s)
- Nancy N Baxter
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
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Abstract
Colorectal cancer is common. As many patients present with advanced disease, an effective screening test would have substantial clinical benefits. Recent progress in understanding the biology of colorectal cancer (and of cancer cells in general) has led to possible new approaches to screening. In particular, there are prospects of developing tests based on analysis of stool, which promise improved accuracy, safety, affordability and patient compliance.
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Affiliation(s)
- R Justin Davies
- Medical Research Council Cancer Cell Unit, Hutchison/MRC Research Centre, Hills Road, Cambridge, CB2 2XZ, UK
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Zacharias T, Jaeck D, Oussoultzoglou E, Bachellier P, Weber JC. First and repeat resection of colorectal liver metastases in elderly patients. Ann Surg 2004; 240:858-65. [PMID: 15492569 PMCID: PMC1356493 DOI: 10.1097/01.sla.0000143272.52505.d6] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the short- and long-term outcome after first and repeat resection in patients older than 70 years. SUMMARY BACKGROUND DATA Liver resection is the best treatment for colorectal liver metastases and is currently increasingly performed in elderly patients. The benefit of resection for these patients needs to be evaluated. METHODS Between 1990 and 2000, 56 first and 16 repeat liver resections were performed in 61 patients older than 70 years. Patients were identified from a prospective database and records were reviewed retrospectively. RESULTS First and repeat liver resection resulted, respectively, in a 0% and 7% postoperative mortality rate and a 41% and 38% complication rate, respectively. Median survival after first resection of 53 patients with R0 resection was 33 months, and the 5-year survival rate was 22%. Factors associated with poor long-term survival in multivariate analysis were extrahepatic disease, high carcinoembryonic antigen level over 200 ng/mL, and the presence of 3 or more liver metastases. Patients without these risk factors showed a median survival of 42 months and a 5-year survival rate of 36%. Repeat liver resection resulted in a median survival of 17 months and in a 3-year survival rate of 25%. CONCLUSION First and repeat liver resection for colorectal liver metastases can be performed safely in patients older than 70 years. A 5-year survival rate similar to those of younger patients can be expected after first liver resection for patients without the presence of risk factors.
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Affiliation(s)
- Thomas Zacharias
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Strasbourg, France
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Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. Am J Med 2004; 116:174-8. [PMID: 14749161 DOI: 10.1016/j.amjmed.2003.09.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Estimates of the sensitivity of screening sigmoidoscopy assume an adequate depth of insertion is reached. However, in clinical practice, the frequency that sigmoidoscopy reaches various lengths of the colon is not known. We assessed the frequency of inadequate reach (depth of <50 cm of the colon) in a large U.S. cohort, according to age and sex. METHODS We performed a cross-sectional study of 15,406 asymptomatic persons aged 50 years or older who underwent screening flexible sigmoidoscopy between April 1997 and October 2001 at sites participating in the Clinical Outcomes Research Initiative, which examines outcomes of endoscopy in "real life" settings. The maximum depth of insertion of the sigmoidoscope was measured in centimeters from the anus and classified as adequate (> or =50 cm) or inadequate (< 50 cm). Patient characteristics as well as procedure-related variables were also recorded. RESULTS Eighteen percent (n = 2801) of subjects had an inadequate examination. In men, the percentage of inadequate examinations increased progressively with age, from 10% (343/3338) in those aged 50 to 59 years to 22% (53/248) in those aged 80 years or older (P <0.001). Inadequate examinations were more common in women at all ages, ranging from 19% (733/3798) in those aged 50 to 59 years to 32% (86/267) in those aged 80 years or older (P <0.001). These associations were confirmed in a multivariable analysis. CONCLUSION Our finding that advancing age and female sex were independently associated with the risk of inadequate reach of screening sigmoidoscopy suggests that the sensitivity of sigmoidoscopy may be lower in these populations. Estimates of the benefits of sigmoidoscopy may need to be tailored to the age and sex of the patient.
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Affiliation(s)
- Louise C Walter
- Division of Geriatrics (LCW, KEC), San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, California 94121, USA.
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O'Brien K, Sweeney BF, Conger N, Fischer JR, Lang KA. Prevalence of proximal adenomas after an adenoma is found on flexible sigmoidoscopy. CANCER DETECTION AND PREVENTION 2004; 27:259-65. [PMID: 12893073 DOI: 10.1016/s0361-090x(03)00099-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenomatous polyps are a precursor of colorectal cancer and a frequent finding on screening flexible sigmoidoscopy (FS). Performance of colonoscopy when a diminutive (<6mm) adenoma is found on FS has been the subject of considerable debate. METHODS We retrospectively reviewed the data from our colorectal cancer screening program for patients with adenoma(s) found on FS. Patients were divided into three groups based on FS findings: (1) an adenoma <6mm in size, (2) multiple non-advanced adenomas or an adenoma 6-10mm in size, or (3) advanced adenoma defined as an adenoma >10mm or with villous histology or high-grade dysplasia or cancer. A comparison of the proximal findings was then made. RESULTS 5291 FS reports were reviewed with 606 (12%) patients having at least one adenoma. Colonoscopy reports were available in 550 patients. Of the 258 patients with a diminutive distal adenoma, 69 (27%) had a proximal adenoma and 13 (5%) had an advanced proximal adenoma on colonoscopy. Of the 164 patients with an adenoma 6-10mm or multiple non-advanced adenomas, 59 (36%) had a proximal adenoma and 13 (8%) had an advanced proximal adenoma. Of the 128 patients with a distal advanced adenoma, 58 (45%) had a proximal adenoma and 15 (12%) had an advanced proximal adenoma. The increase in proximal adenomas across the three groups was significant (P=0.001), and there was a trend for increased prevalence of advanced adenomas (P=0.061). CONCLUSIONS The prevalence of proximal adenomas increased significantly with more advanced lesions found distally at FS, and there was a trend towards a higher prevalence of advanced proximal adenomas. Based on current guidelines, flexible sigmoidoscopy is a screening option that can be used to identify average-risk patients at increased risk of proximal neoplasia.
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Affiliation(s)
- Kevin O'Brien
- Division of General Internal Medicine, Wilford Hall Medical Center, San Antonio, TX, USA.
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Abstract
As the number of elderly patients receiving oncologic therapies increases, the need for better outcome predictors for the critically ill elderly with cancer increases. Physicians should not view age as an indicator of poor ICU outcome, as many elderly patients with cancer will derive the same benefit from intensive care as their younger counterparts. Such a gain can be accomplished without overuse of valuable resources. Similar prognostic factors that are applied to the younger cancer patients should also be applied to the elderly. These parameters, in addition to clinical judgment, can be helpful in deciding who will benefit from ICU care regardless of age. Oncologists and critical care physicians will need to collaborate and change the paradigm of ICU care for the elderly.
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Affiliation(s)
- Kasra Karamlou
- Division of Hematology & Medical Oncology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, L586, Portland, OR 97201, USA
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Leshno M, Halpern Z, Arber N. Cost-effectiveness of colorectal cancer screening in the average risk population. Health Care Manag Sci 2003; 6:165-74. [PMID: 12943152 DOI: 10.1023/a:1024488007043] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer death in North America and in Israel. Risk of CRC increases exponentially with age starting at the age of 50 years. Therefore, people older than 50 years are being considered as an average risk population for CRC. The objective of this study was to obtain an improved assessment of the cost-effectiveness analysis of screening for CRC in the average risk population by using a more accurate technique, namely the Partially Observed Markov Decision Process (POMDP). We conducted a cost-effectiveness analysis within the specific probability rates and costs in Israel. This study revealed that it is highly cost-effective to screen average-risk asymptomatic individuals.
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Affiliation(s)
- Moshe Leshno
- Faculty of Management and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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Abstract
OBJECTIVE Previous studies have reported a migration in the occurrence of colorectal cancer (CRC) toward a proximal colonic location. To assess the potential impact of this, we evaluated recent temporal trends in the United States. METHODS Using the nine population-based cancer registries that constitute the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we identified primary CRCs diagnosed between 1978 and 1998. Temporal changes were evaluated for 3-yr time periods. Age-adjusted incidence rates and the proportions of new diagnoses of CRC were calculated by site and by race. RESULTS We identified 243,861 individuals with CRC during 1978-1998, 51.1% of whom were men. In whites and in blacks, the proportions of new diagnoses of right CRC rose significantly, from 34% and 37% to 40% and 44%, respectively. In contrast, the proportions of left CRC (in whites and blacks) and of rectosigmoid CRC (in whites) decreased significantly over time. For whites and blacks, the age-adjusted incidence rates for right CRC remained unchanged (in whites) or showed a small increase (in blacks), whereas the age-adjusted incidence rates for left CRC (in whites and blacks) and for rectosigmoid CRC (in whites) declined. During 1996-1998, right CRC was the most common site in the oldest age groups (70-79, 80 yr, and older) in whites and in blacks. CONCLUSIONS The proximal migration of CRC over time is not attributed to a true increase in the incidence of right CRC. It is explained by a decrease in the incidence of distal CRC coupled with the aging of the population. Older individuals, in whom the burden of CRC is greatest, and in whom right CRC is the most common site, would be the most adversely affected from CRC screening methods that do not assess the total colon.
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Affiliation(s)
- Linda Rabeneck
- Department of Veterans Affairs Health Services Research, the Gastroenterology and Health Services Research Sections, Houston, Texas, USA
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Abstract
As colorectal cancer screening gains acceptance by the public, the use of colonoscopy will increase. The frequency of surveillance examinations after detection of an adenoma is one of the largest contributors to the cost of colorectal cancer screening. Ten years after the publication of the landmark National Polyp Study, the issue of when to perform surveillance examinations and how often to expect advanced findings remains acute. Current guidelines for surveillance vary across specialty organizations. Individuals with advanced adenomas are at increased risk for recurrent advanced adenomas. The impact of multiple nonadvanced adenomas or a single nonadvanced adenoma on subsequent risk of an advanced adenoma or cancer is less clear. Still less is known about findings on repeat examinations after an initial negative examination, whether after colonoscopy or sigmoidoscopy. The yield after a negative examination is an important consideration in determining the recommended interval for screening colonoscopy. For example, the data supporting a 10-yr interval for screening colonoscopy is only indirect. What little we do know about the yield after negative examinations comes from selected, nonrepresentative populations. Of concern, evidence from several polyp prevention trials demonstrates higher yields for subsequent cancer than would be expected, despite a relatively high use of surveillance procedures in follow-up. Further population-based research on the frequency of use and yield of surveillance examinations is needed. Studies that examine the need and the needed timing of subsequent surveillance are essential to containing costs for screening as well as to informing the public better about what endoscopic screening can and cannot accomplish.
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Affiliation(s)
- Robert E Schoen
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Mandel JS. Sigmoidoscopy screening probably works, but how well is still unknown. J Natl Cancer Inst 2003; 95:571-3. [PMID: 12697843 DOI: 10.1093/jnci/95.8.571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Abstract
Surveillance examinations after detection of an adenoma are one of the largest contributors to the cost of colorectal cancer screening. Screening colonoscopy, beginning at the age of 50 years, is increasing in frequency and becoming part of the zeitgeist. Given the high rate of adenomatous polyp detection on colonoscopy, the amount of time spent and costs consumed by surveillance are likely to grow to significant levels in the coming years. Guidelines for surveillance examinations vary across specialty organizations. Individuals with advanced adenomas are at increased risk for recurrent advanced adenomas. The impact of multiple nonadvanced adenomas or a single nonadvanced adenoma on subsequent risk of an advanced adenoma or cancer is less clear. Recommended surveillance after colorectal cancer has greater consensus, but concerns remain. Studies that predict the need and the needed timing of surveillance remain an important research priority.
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Affiliation(s)
- Robert E Schoen
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Abstract
CRC, the second-leading cause of cancer death in the United States, is a highly preventable disease. Ironically, available and effective screening technologies are not consistently applied, even as new ones are developed. This discordance between preventive opportunity and practice conveys a sobering message regarding nontechnologic issues that must be addressed if the promise of CRC prevention is to be realized. Our response to this message will determine the public health impact of cancer prevention. In the 1980s, cancer chemoprevention was regarded as scientific speculation. Within the last decade, however, cancer has been recognized as a late, nonobligate stage of carcinogenesis, a chronic process that provides time and targets for preventive intervention. Further advances are emerging out of rigorous clinical testing, which remains the limiting factor in transforming ingenious concepts into useful tools for the prevention of CRC. The challenges and rewards of participation in chemoprevention research--both as patients and health care providers-have never been greater.
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Affiliation(s)
- Ernest T Hawk
- Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Division of Cancer Prevention, EPN, Suite 2141, 6130 Executive Boulevard, Bethesda, MD 20892-7317, USA.
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