Year 2018 / Volume 110 / Number 11
Original
Screening-detected colorectal cancers show better long-term survival compared with stage-matched symptomatic cancers

684-690

DOI: 10.17235/reed.2018.5509/2018

Javier A. Cienfuegos, Jorge Baixauli, Patricia Martínez Ortega, Víctor Valentí, Fernando Martínez Regueira, Pablo Martí-Cruchaga, Gabriel Zozaya, José Luis Hernández Lizoain,

Abstract
Purpose: the aim of this study was to compare overall and disease-free survival among patients with colorectal cancer detected via a screening program as compared to those with symptomatic cancer. Material and methods: patients diagnosed via colonoscopy (screening group) and those with clinical symptoms (non-screening) were identified from 1995 to 2014. Demographic, clinical, surgical and pathologic variables were recorded. Stage I, II and III cancers were included. Overall and disease-free survival were calculated at five and ten years after tumor resection and survival was calculated by matching both groups for cancers at stage I, II and III. Results: two hundred and fifty patients were identified as a result of screening procedures and 1,330 patients presented with symptomatic cancers. There were no significant differences in the baseline characteristics between the two groups. Pathologic stage, degree of differentiation, perineural invasion and lymphovascular invasion were lower in the screening group (p < 0.01). Overall and disease-free survival at five and ten years were higher in the screening group (p < 0.01). However, when the subjects were matched for pathologic stage, significant differences were found between the two groups with regard to stage I and III tumors. Disease-free survival in stage III at five years (79.1 vs 61.7%; p < 0.001) and ten years (79.1% vs 58.5%; p < 0.001) were significantly higher in the screening group. Conclusions: patients with stage I and III tumors that were diagnosed via a screening program have a higher overall and disease-free survival at five and ten years.
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References
1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.
2. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.
3. Galceran J, Ameijide A, Carulla M, et al. Cancer incidence in Spain, 2015. Clin Transl Oncol. 2017;19(7):799–825.
4. Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61(5):759–67.
5. Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64(10):1637–49.
6. Betés M, Muñoz-Navas MA, Duque JM, et al. Use of colonoscopy as a primary screening test for colorectal cancer in average risk people. Am J Gastroenterol. 2003;98(12):2648–54.
7. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet (London, England). 2010;375(9726):1624–33.
8. Hewitson P, Glasziou P, Irwig L, et al. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane database Syst Rev. 2007;(1):CD001216.
9. Zauber AG. The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci. 2015;60(3):681–91.
10. Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ. 2014;348:g2467.
11. Chen C, Hoffmeister M, Brenner H. The toll of not screening for colorectal cancer. Expert Rev Gastroenterol Hepatol. 2017;11(1):1–3.
12. Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366(8):697–706.
13. Inadomi JM. Screening for Colorectal Neoplasia. N Engl J Med. 2017;376(16):1599–600.
14. Sebastian E, Courtier R, Macià F, et al. The impact of screening on short-term outcome after surgery for colorectal cancer. Rev Esp Enferm Dig. 2017;109(7):485–90.
15. Mansouri D. Lower morbidity and improved outcomes in patients with screen-detected colorectal cancer. Rev Esp Enferm Dig. 2017;109:483–4.
16. Amri R, Bordeianou LG, Sylla P, et al. Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surg. 2013;148(8):747–54.
17. Gill MD, Bramble MG, Hull MA, et al. Screen-detected colorectal cancers are associated with an improved outcome compared with stage-matched interval cancers. Br J Cancer. 2014;111(11):2076–81.
18. Morris EJA, Whitehouse LE, Farrell T, et al. A retrospective observational study examining the characteristics and outcomes of tumours diagnosed within and without of the English NHS Bowel Cancer Screening Programme. Br J Cancer. 2012;107(5):757–64.
19. American Joint Committee on Cancer., editor. Colon and rectum. In: AJCC cancer staging manual. 7th ed. New York, NY; 2010. p. 145–66.
20. Keats AS. The ASA classification of physical status--a recapitulation. Anesthesiology. 1978;49(4):233–6.
21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
22. Chang GJ, Kaiser AM, Mills S, et al. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55(8):831–43.
23. Heald R, MacFarlane JK. Surgical management of rectal cancer. Br J Surg. 1995;82(12):1704–5.
24. Milsom JW, de Oliveira O, Trencheva KI, et al. Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum. 2009;52(7):1215–22.
25. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [Internet]. [cited 2017 Mar 22]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf
26. Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51.
27. Washington MK, Berlin J, Branton P, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009;133(10):1539–51.
28. Batsakis JG. Nerves and neurotropic carcinomas. Ann Otol Rhinol Laryngol. 1985;94(4 Pt 1):426–7.
29. Sato T, Ueno H, Mochizuki H, et al. Objective criteria for the grading of venous invasion in colorectal cancer. Am J Surg Pathol. 2010;34(4):454–62.
30. Hamilton SR, Bosman FT, Boffetta P, et al. Carcinoma of the colon and rectum. In: WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer; 2010. p. 134–46.
31. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer. N Engl J Med. 2005;352(5):476–87.
32. Grávalos Castro C, Maurel Santasusana J, Rivera Herrero F, et al. SEOM clinical guidelines for the adjuvant treatment of colorectal cancer. Clin Transl Oncol. 2010;12(11):724–8.
33. Arredondo J, Baixauli J, Beorlegui C, et al. Prognosis factors for recurrence in patients with locally advanced rectal cancer preoperatively treated with chemoradiotherapy and adjuvant chemotherapy. Dis Colon Rectum. 2013;56(4):416–21.
34. Labianca R, Nordlinger B, Beretta GD, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2013;24 Suppl 6:vi64-72.
35. GLOBOCAN Cancer Fact Sheets: colorectal cancers [Internet]. [cited 2018 Jan 9]. Available from: http://globocan.iarc.fr/old/FactSheets/cancers/colorectal-new.asp
36. Benson AB, Venook AP, Cederquist L, et al. Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017;15(3):370–98.
37. Pande R, Froggatt P, Baragwanath P, et al. Survival outcome of patients with screening versus symptomatically detected colorectal cancers. Colorectal Dis. 2013;15(1):74–9.
38. McClements PL, Madurasinghe V, Thomson CS, et al. Impact of the UK colorectal cancer screening pilot studies on incidence, stage distribution and mortality trends. Cancer Epidemiol. 2012;36(4):e232-42.
39. Nagtegaal ID, Allgood PC, Duffy SW, et al. Prognosis and pathology of screen-detected carcinomas: how different are they? Cancer. 2011;117(7):1360–8.
40. Chang DT, Pai RK, Rybicki LA, et al. Clinicopathologic and molecular features of sporadic early-onset colorectal adenocarcinoma: an adenocarcinoma with frequent signet ring cell differentiation, rectal and sigmoid involvement, and adverse morphologic features. Mod Pathol. 2012;25(8):1128–39.
41. Kay BR, Witte DL. The impact of cancer biology, lead time bias, and length bias in the debate about cancer screening tests. J Insur Med. 1991;23(2):102–4.
42. Duffy SW, Nagtegaal ID, Wallis M, et al. Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival. Am J Epidemiol. 2008;168(1):98–104.
43. Mansouri D, McMillan DC, Crighton EM, et al. Screening for colorectal cancer: what is the impact on the determinants of outcome? Crit Rev Oncol Hematol. 2013;85(3):342–9.
44. Fletcher RH. Colorectal cancer screening on stronger footing. N Engl J Med. 2008;359(12):1285–7.
45. Delgado-Rodríguez M, Llorca J. Bias. J Epidemiol Community Health. 2004;58(8):635–41.
46. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane database Syst Rev. 2006;(1)(1):CD005033.
47. Horowitz M, Neeman E, Sharon E, et al. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nat Rev Oncol. 2015;12(4):213–26.
48. Richards CH, Platt JJ, Anderson JH, et al. The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer. Ann Surg. 2011;254(1):83–9.
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A. Cienfuegos J, Baixauli J, Martínez Ortega P, Valentí V, Martínez Regueira F, Martí-Cruchaga P, et all. Screening-detected colorectal cancers show better long-term survival compared with stage-matched symptomatic cancers. 5509/2018


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Publication history

Received: 31/01/2018

Accepted: 25/05/2018

Online First: 23/07/2018

Published: 30/10/2018

Article revision time: 109 days

Article Online First time: 173 days

Article editing time: 272 days


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