Patterns of Large Bowel Cancer by Subsite, Age, Sex and Marital Status

Prognostic value of estrogen receptor-α and progesterone receptor in curatively resected colorectal cancer: a retrospective analysis with independent validations

Background

Prognostic assessment is crucial for optimal treatment. The aim of our study was to investigate the potential impact of estrogen receptor-α (ER-α) and progesterone receptor (PR) on the prognosis of colorectal cancer (CRC) patients who received curative resection.

Methods

Retrospective evaluation of two independent cohorts of CRC patients maintained prospectively in 2009–2010 (training set) (n = 148) and 2007–2009 (internal validation set) (n = 485). Furthermore, we used an external independent CRC cohort from The Cancer Genome Atlas (TCGA) (n = 511) for further validation. ER-α and PR expression as well as other potential prognostic factors were retrospectively evaluated in training set with respect to overall survival (OS), local relapse free survival (LRFS) and distant metastasis free survival (DMFS). The prognostic factors found in training set will be validated in two validation cohorts.

Results

On univariate analysis for the training set, OS, LRFS and DMFS were not associated with PR expression. While patients with ER-αexpression were found to have poor prognosis. In addition, multivariate analysis showed that ER-αexpression maintained significance with respect to OS (HR, 5.06; p = 0.002), LRFS (HR, 8.81; p = 0.002) and DMFS (HR, 8.07; p = 0.004). Similarly, ER-α expression showed prognostic significance with respect to OS with hazard ratios (HRs) of 1.572 (95% CI: 1.001–2.467, p = 0.049) and 1.624 (95% CI: 1.047–2.520, p = 0.031) for the internal and external validation cohort, respectively.

Conclusion

ER-α expression was a biomarker of poor prognosis and it might inform treatment decision for high risk CRC patients. However, PR expression was not associated with survival outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5918-4) contains supplementary material, which is available to authorized users.

Transcriptional analysis of estrogen receptor alpha variant mRNAs in colorectal cancers and their matched normal colorectal tissues

Estrogen is involved in suppression of colorectal cancer development and exerts its function via estrogen receptors alpha, beta and their splicing variants. Whether the recently indentified ER-alpha splicing variants, ER-alpha36 and ER-alpha46, play a role in colorectal cancer development is unknown. In this study, we quantified the mRNA copy numbers of wild type ER-alpha (ER-alpha66), ER-alpha46 and ER-alpha36 in 35 colorectal cancers and their matched normal colorectal tissues by quantitative real-time PCR assay, and correlated their mRNA levels with the clinicopathological properties of the tumors. We found that ER-alpha66, ER-alpha46 and ER-alpha36 mRNAs were coexpressed in all colorectal cancers and their matched normal tissues. The decreased mRNA levels of ER-alpha36 and ER-alpha46 whereas no difference of ER-alpha66 mRNA was observed in colorectal cancers compared to their matched normal tissues. Moreover, change in the expression of ER-alpha36 mRNA level was correlated with Dukes' stage of the tumor and the lymph node metastasis. ER-alpha36 mRNA was decreased significantly in Dukes' C+D compared to Dukes' A+B stage tumors (P=0.017), and the expression of ER-alpha36 mRNA in N(1)/N(2) was lower than that in N(0) lymph node metastasis (P=0.049). So ER-alpha36 and ER-alpha46 might be implicated in the development and progression of colorectal cancers.

Colorectal carcinoma: a retrospective, descriptive study of age, gender, subsite, stage, and differentiation in Iran from 1995 to 2001 as observed in Tehran University

PURPOSE

Colorectal carcinoma is one of the most common cancers in the world as well as in Iran. There are differences in subsite of the carcinoma when considering age and gender. This study was designed to describe the distribution of colorectal carcinoma by age at diagnosis, gender, and subsite of the tumor. These factors also are evaluated in conjunction with disease stage and tumor differentiation at the time of diagnosis.

METHODS

Data from 419 patients from a population that receives no screening between April 1995 and March 2001 operated on in the Cancer Institute and Imam Khomieni Hospital with a diagnosis of colorectal cancer were used to describe distribution of the colorectal carcinoma by age, gender, tumor subsite and pathology, and stage at diagnosis.

RESULTS

There were 403 (96.2 percent) cases of adenocarcinoma. Males and females constituted 52.4 and 47.6 percent of cases, respectively. The mean age was 52.3 years. Patients were divided into two age groups (40 years and younger, and older than 40 years); 16.4 percent of patients had tumors in the proximal colon and 83.6 percent in distal parts. Most patients were Stage II and III (48.1 and 33.4 percent, respectively). Tumor subsite distribution was almost the same between the two age groups (aged 40 years and younger: proximal, 18.5 percent, and distal, 81.5 percent; older than aged 40 years: proximal, 15.7 percent, and distal, 84.3 percent). Most patients in the younger age group were Stage III (45 percent) and in the older age group were Stage II (53.2 percent; P<0.001). Tumor differentiation proportions in patients aged 40 years and younger were: good, 24.4 percent; moderate, 53.6 percent; poor, 22 percent; and in patients older than aged 40 years were: good, 41.5 percent; moderate, 52.6 percent; poor, 5.9 percent (P<0.001). There were no differences in stage and tumor differentiation between two genders, but most of the patients with tumors in proximal colon were males (62.5 percent; P=0.1).

CONCLUSIONS

Most of the colorectal carcinomas were in distal parts in our study, so most of these carcinomas can be detected by proctosigmoidoscopy. Because younger patients had more advanced disease, the importance of screening and "clinical suspicion" in the young is important.

Incidence of anal carcinoma in Vaud, Switzerland, 1979–2001

Substantial rises in anal cancer incidence have been registered over the last few decades in the USA and a few Nordic countries. Incidence trends in the Swiss population of Vaud (about 602,000 inhabitants) over the period 1979-2001 were considered. Rates were around 0.3-0.5 per 100,000 men (age-standardized, world population) and 1.1-1.4 per 100,000 women, in the absence of any consistent trend over time. The epidemiology of anal cancer appears therefore different in this Swiss population as compared with North America and northern Europe.

Socioeconomic variation in colon cancer tumour factors associated with poorer prognosis

Analysis of population-based registry data (n=7393) showed that more deprived colon cancer patients had lower risk of the mucin-producing adenocarcinoma subtype, proximal subsite (to the descending colon), and no greater risk of high-grade tumours. Tumour factors therefore appear unlikely to account for socioeconomic gradients in survival.

The influence of reproductive and hormonal factors on the risk of colon and rectal cancer in women

A case-control study was conducted between 1992 and 1996 in six Italian areas. It included 537 women with colon cancer, 291 women with rectal cancer and 2081 control women in hospital for acute conditions, unrelated to hormonal or gynaecological diseases. A higher age at menopause was associated with increased colon cancer risk (odds ratio (OR) for > or = 53 years compared with < 50 years = 1.39, 95% confidence interval (CI) 1.04-1.87). Among parous women, a significant trend of decreasing colon cancer risk with increasing number of births was seen for colon (OR for > or = 4 births compared with 1 birth = 0.62, 95% CI 0.42-0.90), but not for rectal cancer. Nulliparous women, however, were at lower risk than women with a single birth, and age at first birth was directly associated with risk. While oral contraceptive use showed no significant influence, ever users of hormone replacement therapy had a reduced risk of rectal cancer (OR = 0.56, 95% CI 0.31-1.01). Thus, the association of colorectal cancer with reproductive and menstrual factors is neither strong nor consistent.

Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Denmark

In a previous investigation, statistical modelling was used to examine the relationship between large-bowel-cancer incidence and age, time period and birth cohort by anatomic sub-site and sex, using data from the Connecticut Tumor Registry (CTR) for the period 1950 to 1984. This analysis revealed differences in age-period-cohort patterns that suggested etiologic distinctions among sub-site groupings and between the sexes. To test the generalizability of the Connecticut findings, we have conducted a similar age-period-cohort analysis using data from the Danish Cancer Registry (DCR) for the period 1953 to 1987. Cancers of the large bowel were classified into 6 anatomic sub-sites: cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum. Data were fitted to log-linear age-period-cohort models. If we interpret differences in age-period-cohort patterns as reflecting etiologic distinctions, the Denmark analysis, in conjunction with the Connecticut findings, was consistent with there being etiologic distinctions between cancers of the colon vs. the rectum in both males and females, between cancers of the cecum and the ascending colon vs. the remainder of the colon in females and between males vs. females for cancers of the sigmoid colon and rectum. Cancers of the cecum and the ascending colon were the most similar between males and females. Due to the ambiguities of age-period-cohort modelling, these should be considered only tentative conclusions that can be tested by analytical epidemiologic studies.

Trends in subsite distribution of colorectal cancers and polyps from the Vaud Cancer Registry

BACKGROUND

Changes in the subsite distribution of malignant and benign colorectal tumors over the last few years have been reported in several series. They may be related to changes in diagnostic accuracy or to real changes in incidence.

METHODS

Trends in incidence and subsite distribution of colorectal cancers and polyps between 1978 and 1988 have been analyzed using data from the Cancer Registry of the Canton Vaud, Switzerland (530,000 inhabitants in 1981), which has adopted standardized methods for identification and registration not only of malignant, but also of benign colorectal lesions.

RESULTS

Age-standardized incidence rates for malignant tumors of the ascending colon in men increased from 4.6/100,000 in 1978-80 to 6.4/100,000 in 1987-88, and in women from 4.9 to 6.5. Incidence was approximately stable for transverse, descending, and sigmoid colon, whereas a decline was observed for "other and unspecified" colon cancers. Rates for rectal cancer declined by over 10% in both sexes, although the trends were not linear across calendar periods in each sex. Overall colorectal cancer incidence was relatively stable in both sexes in the Vaud population. In terms of proportional distribution, the percentage of cases in the ascending colon increased from 27% in 1978-83 to 33% 1984-88 (P < 0.05). Reliable incidence data for polyps were available for 1979 and from 1982 to 1988. Rates for ascending colon polyps increased from 1.0/100,000 in 1979-83 to 5.0/100,000 in 1987-88 in men, and from 0.4 to 2.7 in women. Incidence rates were higher, although to a lesser extent, for transverse colon and for descending colon polyps in men only. As in the case of malignant tumors, incidence rates declined between the early and the late 1980s for rectal polyps as well as for "other and unspecified" colon polyps. Overall, colorectal polyp incidence was stable around 45/100,000 for men but increased from 19 to 27/100,000 for women. With reference to proportional distributions, significant increases were observed for ascending (from 8.4% to 16.8%) and, to a lower degree, transverse colon (from 8.4% to 11.0%). No appreciable change was observed for any other subsite, except a decline for "other and unspecified" colonic polyps.

CONCLUSIONS

The observation of similar changes in distribution for benign and malignant tumors may suggest the importance of improved diagnostic accuracy (particularly total colonoscopy) for lesions arising in the proximal colon.

Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Connecticut

In order to investigate etiologic distinctions among the anatomic sub-sites of the large bowel by sex, the relationship between large-bowel-cancer incidence and age at diagnosis, time period at diagnosis, and birth cohort was analyzed by anatomic sub-site and by sex, using data from the Connecticut Tumor Registry. Included in the study were all incident large-bowel-cancer cases occurring between 1950 and 1984 among Connecticut residents aged 40 to 79. Cancers of the large bowel were classified into 5 anatomic sub-sites: ascending colon (including cecum), transverse colon (including flexures), descending colon, sigmoid colon, and rectum (including rectosigmoid junction, anal canal, and anus). The data were fitted to log-linear age-period-cohort models. For each of the sub-sites, the age-period-cohort patterns for males and females differed. Within each sex, sub-site groupings with common patterns were indicated. Among males, the age-period-cohort patterns for the colon sub-sites were fairly similar; but the pattern for the rectum differed markedly from that for the colon sub-sites. There were secondary differences among the colon sub-sites that pointed to a secondary distinction between the right and the left colons. Among females, the age-period-cohort patterns for the left colon sub-sites and the rectum were fairly similar. The pattern for the transverse colon differed moderately from that of the left colon, and differed substantially from that of the rectum and the ascending colon. The ascending colon differed markedly from each of the other sub-sites. It is possible that these differences in age-period-cohort patterns reflect etiologic distinctions among sub-site groupings and between the sexes.