Survival for colon and rectal cancer in Estonia: Role of staging and treatment

Abstract

Background. International comparisons have indicated low colorectal cancer (CRC) survival in Estonia, compared to other European countries. The objective of this paper is to analyse long-term survival as well as staging and treatment patterns of CRC in Estonia. Material and methods. The analysis included all incident cases of CRC diagnosed in Estonia in 1997 (n ϭ 546), identifi ed through the Estonian Cancer Registry and followed up for 10 years after diagnosis. Staging and treatment data were retrospectively collected from medical records. Relative survival rate (RSR) was used to estimate the outcome. Results and conclusion. The 5-year RSR was 51% for colon cancer and 38% for rectal cancer; the corresponding 10-year RSR was 50% and 39%. We observed no excess mortality for early disease. For stages II and III, the survival was markedly higher in colon cancer (5-year RSR 79% and 66%, respectively) compared to rectal cancer (66% and 30%, respectively). Around 30% of cases were diagnosed with distant disease. Among radically operated colon and rectal cancer patients, the 10-year RSR was 90% and 70%, respectively. Most patients with available pathological information had one to four lymph nodes examined. Survival has notably improved for colon cancer, but not for rectal cancer in Estonia. High proportion of cases with distant metastasis at fi rst diagnosis along with inadequate staging and low proportion of patients treated with curatively intended surgery and appropriate chemotherapy and radiotherapy may have contributed to this outcome. Progress could be achieved by earlier diagnosis and implementing higher standards for staging and treatment. These conclusions are likely to be relevant also for other Eastern European countries.

Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2)

“…These trends are likely to be attributable to earlier diagnosis, reduction in postoperative mortality, 52 and more effective treatment. 53,54 For rectal cancer, preoperative radiotherapy and total mesorectal excision reduce local recurrence and extend survival, 55–57 which could account for improvements noted in Canada, Finland, the Netherlands, Norway, Sweden, and the USA, where survival was already high (55–60%) for patients diagnosed in 1995–99 and rose further for those diagnosed during 2005–09 (62–65%). These trends accord with those reported from the Netherlands, 58 Scotland, the Nordic countries, 59 and elsewhere in Europe.…”

Colorectal cancer survival among Malaysia population: data from the Malaysian National Cancer Registry

“…Previous findings from MNCR in the period between 2008 and 2009 also reported that patients diagnosed with stage IV had the highest risk of death compared to patients with earlier stages ( 13 ). In Estonia, patients with advanced stages of colon and rectal cancers have poor 5-year survival rates of 2% and 4%, respectively ( 38 ). Similarly, the relative survival at 5 years was 9% among those with late-stage diagnosis in Mumbai, India ( 39 ).…”

Changes in the quality of care of colorectal cancer in Estonia: a population-based high-resolution study

“…6 A more detailed analysis of the 1997 Estonian CRC cohort showed extremely low quality of pathological examination, inadequate staging and insufficient use of neoadjuvant and adjuvant therapies. 7 A recent analysis of Estonian Cancer Registry data demonstrated that both overall Strengths and limitations of this study ► A population-based sample drawn from the nationwide cancer registry. ► Uniform data gathering from patient records by specialised doctors according to EUROCARE High-Resolution study protocols and ability to directly compare two incidence years.…”

“…A more detailed analysis of the 1997 Estonian CRC cohort showed extremely low quality of pathological examination, inadequate staging and insufficient use of neoadjuvant and adjuvant therapies. 7 …”