Incidence, Therapy and Prognosis of Colorectal Cancer in Different Age Groups

Abstract

Purpose: Determination of frequency, treatment modalities used and prognoses of colorectal cancer in a population-specific analysis in relation to age. Material and Methods:In 1999 and 2000, 644/6,016 patients were documented as having colorectal carcinomas in the Cancer Registry of Rostock. 39 patients were excluded (16 cases: "in situ" carcinomas; 23 cases: insufficient data). Three age groups were formed: < 60 years, 60-74 years; ≥ 75 years. Results:The relative percentage of colorectal cancer increases with advanced age (< 60 years 7%; 60-74 years 12%, ≥ 75 years 15%; p < 0.001). In older patients with stage III carcinomas, adjuvant treatment was done less frequently in accordance with the treatment recommendations (< 60 years 83-89%; 60-74 years 67-77%; ≥ 75 years 29-36% according to stage and tumor localization); in stage IV, the use of chemotherapy was reduced (< 60 years 87.5-100%; 60-74 years 38-47%; ≥ 75 years 33-37%). In the univariate analysis, age ≥ 75 years (4-year survival rates: < 60 years 68 ± 4.1%; 60-74 years 58 ± 2.8%; ≥ 75 years 38 ± 3.7%), UICC stage and surgical treatment had a significant effect on prognosis. Adjuvant treatment had no significant effect on the whole population but on patients with UICC stage III and IV. In the multivariate analysis, however, the only independent prognostic parameters were age ≥ 75 years (p = 0.001), performance of chemotherapy (colon cancer) or radiochemotherapy (rectal cancer; p = 0.004-0.001), and tumor stage (p = 0.045-0.001). Sex (p = 0.063) and age between 60 and 74 years (p = 0.067) had a borderline influence. Conclusion:With increasing age, there is a departure in daily practice from the treatment recommendations. The patient's prognosis is dependent upon age (especially ≥ 75 years), tumor stage, and therapy. ZusammenfassungZiel: Bestimmung der Häufigkeit, der Therapiemodalitäten und der Prognose von Patienten mit kolorektalen Tumoren in einer bevölkerungsspezifischen Analyse in Bezug auf das Alter. Material und Methodik: Zwischen 1999 und 2000 wurden im Krebsregister Rostock 644/6 016 Patienten mit kolorektalen Karzinomen dokumentiert. 39 Patienten wurden ausgeschlossen (16 Fälle: In-situ-Karzinome; 23 Fälle: Insuffiziente Daten). Drei Altersgruppen wurden gebildet: < 60 Jahre, 60-74 Jahre, ≥ 75 Jahre.Ergebnisse: Der relative Anteil kolorektaler Karzinome steigt mit zunehmendem Alter (< 60 Jahre 7%; 60-74 Jahre 12%; ≥ 75 Jahre 15%; p = 0,001). Mit zunehmendem Alter wurden im Stadium III die Behandlungen weniger häufig in Übereinstimmung mit den Therapieempfehlungen durchgeführt (< 60 Jahre 83-89%; 60-74 Jahre 67-77%; ≥ 75 Jahre 29-36% gemäß Stadium und Tumorlokalisation); im Stadium IV nahm der Anteil der Patienten, die eine Chemotherapie erhielten, mit zunehmendem Alter ab (< 60 Jahre 87,5-100%; 60-74 Jahre 38-47%; ≥ 75 Jahre 33-37%). In der univariaten Analyse hatten das Alter ≥ 75 Jahre (4-Jahres-Überlebensraten: < 60 Jahre 68 ± 4,1%; 60-74 Jahre 58 ± 2,8%; ≥ 75 Jahre 38 ± 3,7%), das UICC-Stadium und die chirurgische Therapie einen signifikanten...

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

“…Thus, different age ranges of the populations studied, or different age groups chosen for the analyses, together with a variable prevalence of nonneoplastic diseases in the evaluated series, can explain the discordant results in the scientific literature regarding age and colorectal cancer. Indeed, different authors have found an independent unfavourable effect of increasing age (Korenaga et al, 1991;Gasser et al, 1992;Crocetti et al, 1996;D'Eredita et al, 1996;Wolters et al, 1996;Payne and Meyer, 1997;Tominaga et al, 1997;Heys et al, 1998;Lagautriere et al, 1998;Fietkau et al, 2004;Munemoto et al, 2004), of the youngest and oldest age ranges, indifferently (Chung et al, 1998;Cerottini et al, 1999;Massacesi et al, 2002) or even of young age (Cai et al, 2005), while other investigators were not able to demonstrate any prognostic effect at all (Ponz de Leon et al, 1992;Wang et al, 2000;Mitry et al, 2004;Latkauskas et al, 2005). Only JanssenHeijnen et al (2005) evaluated relative survival of patients with several cancers, utilising data from the Southern Netherlands Cancer Registry.…”

Cancer survival analysis in Hamburg 1995–2003: Assessing the data quality within a population-based registry

“…The similarity of relative survival among male and female patients, a decline in higher age-groups and the improvement during the nineties correspond to observations within other population-based survival studies [2,6,30,32]. Still the absence of further increase for the most recent patient cohorts and an altogether 5-year relative survival ratio of 50%, which ranks among the lower estimates of comparative registries, remain difficult to be interpreted (Figure 3a).…”

“…Comprehensive cancer survival analysis based on epidemiological registry data from Hamburg has not yet been performed, and comparable results from Northern Germany are scarcely published [6,7]. Meanwhile several neighbouring European cancer registries have established survival estimates as part of their periodic reports providing a sound basis for quality assessment within clinical oncology [10Á14].…”

Evaluation von Fallpauschalen in der Radioonkologie

“…Für die Sicherstellung der radioonkologischen Versorgung war somit eine Überprüfung dringend erforderlich. Dies gilt insbesondere vor dem Hintergrund des demographischen Wandels und der zunehmenden Indikation zu kombinierten Therapieschemata [8,15,20,23].…”