Population-Based Registration of Unselected Colorectal Cancer Patients: Five-Year Survival in the Region of Bonn/Rhine-Sieg, Germany

Zusammenfassung

Einleitung: Für das kolorektale Karzinom (KRK) liegen nur wenige und oft unvollständige epidemiologische Daten vor. Deshalb wurde populationsbezogen das 5-Jahres-Überleben von Patienten mit neu diagnostiziertem KRK in der Region Bonn/Rhein-Sieg untersucht. Methode: Das Tumorstadium wurde sowohl über die behandelnden Ärzte als auch über die zuständigen Pathologen und die initiale Therapie sowie der weitere Krankheitsverlauf wurden mit einem standardisierten Fragebogen dokumentiert. Ergebnisse: Zwischen Juni und November 1994 konnten 348 Patienten erfasst werden. Männer erkrankten im Median mit 69 Jahren (n = 160), Frauen mit 72 Jahren (n = 188). Entsprechend der UICC-Klassifikation lag bei 18, 26, 23 und 26 % ein Stadium I-IV vor; bei 7 % der Patienten blieb das Tumorstadium unklar. Eine adjuvante (Radio-)Chemotherapie erfolgte lediglich bei 44/89 (49 %) der infrage kommenden Patienten. Das 5-Jahres-Gesamtüberleben (OS) aller Patienten betrug 41 %, das relative Gesamtüberleben 54 %. Obwohl das krankheitsfreie Überleben (DFS) in den frühen UICC-Stadien signifikant besser war, unterschied sich das OS der Patienten mit nicht metastasiertem KRK nicht signifikant. Junge Patienten (< 50 Jahre) wiesen jedoch ein signifikant geringeres DFS auf. Das OS der Patienten mit KRK lag im europäischen Durchschnitt, war jedoch im Vergleich zu den US-amerikanischen Daten signifikant schlechter. Diskussion: Der hohe Anteil bereits initial metastasierter Karzinome und die geringe Rate adjuvant durchgeführter (Radio-)Chemotherapien war enttäuschend. Die Früherkennung asymptomatischer Patienten und die standardisierte Durchführung etablierter adjuvanter Therapieverfahren muss deshalb intensiviert werden.

Abstract

Introduction: Epidemiological data of colorectal cancer are sparse and often incomplete. Therefore, we initiated a population-based examination of five-year survival of colorectal cancer patients. Methods: For complete registration, diagnosis and tumour stage of all patients in the region of Bonn/Rhine-Sieg were assessed independently according to reports of medical practitioners and pathologists. Each patient was followed by a standardised questionnaire during a period of five years. Results: Between June and November, 1994 348 patients were registered. Median age at diagnosis was 69 years for males (n = 160) and 72 years for females (n = 188). According to the UICC classification 18, 26, 23 and 26 % had stage I-IV tumours, respectively; the tumour stage remained unclear in 7 %. Adjuvant (radio)-chemotherapy was indicated in 89 patients, but only 49 % of these were treated. Five-year overall survival (OS) and relative overall survival were 41 and 54 %, respectively. Although disease-free survival (DFS) was significantly better for early stage colorectal cancer, OS did not differ significantly between stage I and stage III tumours. Young patients diagnosed before the age of 50 had a significantly lower DFS. These data were comparable with other European countries but were lower than data reported in the USA. Discussion: The high rate of patients with stage IV colorectal cancer and the low proportion of patients receiving adjuvant (radio)-chemotherapy according to international or national consensus recommendations were disappointing. Although data were comparable with other European countries more efforts are necessary to establish effective screening programs for asymptomatic patients and to increase the willingness for standardised adjuvant treatment.

Schlüsselwörter

Epidemiologie - kolorektales Karzinom - Gesamtüberleben - krankheitsfreies Überleben

Key words

Epidemiology - colorectal cancer - overall survival - disease-free survival

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