Clinical Research Papers:
Survival of patients with symptom- and screening-detected colorectal cancer
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Hermann Brenner1,2,3, Lina Jansen1, Alexis Ulrich4, Jenny Chang-Claude5, Michael Hoffmeister1
1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
2Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
3German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
4Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
5Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
Hermann Brenner, e-mail firstname.lastname@example.org
Keywords: colonoscopy, colorectal cancer, fecal occult blood test, screening, survival
Received: March 07, 2016 Accepted: April 26, 2016 Published: May 17, 2016
Background: An increasing proportion of colorectal cancer (CRC) patients are diagnosed by screening rather than symptoms.
Aims: We aimed to assess and compare prognosis of patients with screen-detected CRC and symptom-detected CRC.
Methods: Overall and CRC specific mortality over a median follow-up of 4.8 years was assessed according to mode of diagnosis (symptoms, screening colonoscopy, fecal occult blood test [FOBT], other) in a multi-center cohort of 2,450 CRC patients aged 50-79 years recruited in Germany in 2003-2010.
Results: 68%, 11% and 10% were detected by symptoms, screening colonoscopy and FOBT, respectively. The screen-detected cancers had a more favorable stage distribution than the symptom-detected cancers (68% versus 50% in stage I or II). Age- and sex adjusted hazard ratios (HRs) of total mortality with 95% confidence intervals (95% CIs) compared to symptom-detected cancers were 0.35 (0.24-0.50) and 0.36 (0.25-0.53) for screening colonoscopy and FOBT detected CRCs, respectively. HRs were only slightly attenuated and remained highly significant after adjustment for stage and multiple other covariates (0.50 (0.34-0.73) and 0.54 (0.37-0.80), respectively). Even stronger associations were seen for CRC specific mortality. Patients with screen-detected stage III CRC had as good CRC specific survival as patients with symptom-detected stage I or II CRC.
Conclusions: Patients with screen-detected CRC have a very good prognosis far beyond the level explained by their more favorable stage distribution. Mode of detection is an important, easy-to-obtain proxy indicator for favorable diagnosis beyond earlier stage at diagnosis and as such may be useful for risk stratification in treatment decisions.
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