Recurrence, death risk, and related factors in patients with stage 0 colorectal cancer

Abstract

In this study, the National Health Insurance Research Database of Taiwan was used to examine the recurrence and death risk for stage 0 colorectal cancer patients. We examined stage 0 colorectal cancer patients to identify factors causing recurrence and death. This is a retrospective study, and stage 0 colorectal cancer patients that are registered in the Taiwan Cancer Registry of the Health Promotion Administration in 2007 to 2012 were included. The database was linked to the National Health Insurance Research Database, and subjects were followed up until the end of 2016. The mean follow-up period was 69 months. Bivariate analysis methods (log-rank test) and Cox proportional hazards model were used to evaluate the risk of recurrence and death and demographic characteristics, economic factors, environmental factors, health factors, treatment and hospitals, and absence/presence of postoperative tests were used to examine related risk factors. Our study showed that the 5-year recurrence rate and 5-year mortality rate for stage 0 colorectal cancer are 1.68% and 0.6%, respectively. For stage 0 colorectal cancer, age (61–74 years) is the only factor affecting recurrence in patients (hazard ratio (HR) = 2.44; 95% CI: 1.41–4.22), while age >75 years (HR = 4.35; 95% CI: 1.14–16.68) and Charlson Comorbidity Index >4 points (HR = 7.20, 95% CI: 2.60–19.94) can increase the risk of death. In contrast, patients who underwent one (HR = 0.27, 95% CI: 0.10–0.71) and two or more colonoscopies (HR = 0.26, 95% CI: 0.10–0.70) within 2 years after surgery can reduce the risk of death from stage 0 colorectal cancer. In addition, the risk of recurrence is higher in patients who underwent colonoscopic polypectomy (HR = 2.07, 95% CI: 0.98–4.33) and patients with rectal cancer (HR = 2.74, 95% CI: 0.96–7.83), but these differences are not statistically significant ( P > .05). From this study, we can see that age and comorbidity index increase the risk of recurrence and death for stage 0 colorectal cancer, while postoperative colonoscopy can decrease the risk of death.

Examining the Factors That Affect the Diagnosis of Patients with Positive Fecal Occult Blood Test Results

“…The analysis results in Table 4 showed that the risk of developing non-CRC and CRC, compared to normal diagnoses, was higher in males than in females, which is consistent with previous study findings [23,26,52]. Therefore, male patients with positive FOBT results should be cautious of the follow-up risk of developing colorectal cancer and colorectal cancer diagnosis and treatment.…”

“…The analysis of the region of the medical unit that conducted follow-up examinations showed that positive FOBT cases were mostly in Northern, Central, and Southern Taiwan. Because of the predominance of metropolitan areas, demographic characteristics, and medical accessibility in the three regions [26,[37][38][39][40][41][42][43], the willingness and behavior of FOBT-positive groups to be followed up has increased, which in turn influences the distribution of diagnosis. The actual number of FOBT-positive cases in the 50 years and 71-75 years population who underwent FOBT was lower than in other age groups (Table 1), thus the number of cases diagnosed was low.…”

“…The results of the region of the medical institution that conducted follow-up examinations were consistent with the related literature mentioned above. For example, due to demographic characteristics and medical resource distribution [26,[37][38][39][40][41][42][43], the majority of the people that underwent screening was in Northern Taiwan. The mean age of cases that underwent FOBT was 60.04 years, and the mean age of the ones that underwent screening for the first time was 58.9 years, which were similar.…”

Disease recurrence after colorectal cancer surgery in the modern era: a population-based study

“…Another factor is the ongoing scientific debate regarding lifestyle, comorbidities, and recurrences wherein some studies suggest that comorbidity is also associated risk of recurrence and poorer survival. [ 43 , 44 ] Moreover, patients with higher ASA scores will less likely be found eligible for adjuvant chemotherapy. Therefore, analyzing disease recurrence in light of these abovementioned competing risks is important.…”

Chronic Obstructive Pulmonary Disease Increases the Risk of Mortality among Patients with Colorectal Cancer: A Nationwide Population-Based Retrospective Cohort Study

“…The TwCR has record completeness of 98.4%, and it has been regarded as one of the world's highest-quality cancer registries [26]. Furthermore, since 2002, the TwCR has established a long-form database including cancer staging, detailed initial treatment, and recurrence information, which researchers have widely used for cancer recurrence studies [27]. In addition, the dataset provided demographic information and medical records of patients for further analysis, such as age, sex, date of birth, death, causes of death, cancer stage, recurrence condition, disease diagnosis, and inpatient and outpatient department prescriptions.…”