Publication

Relative Survival is an Adequate Estimate of Cancer-Specific Survival: Baseline Mortality-Adjusted 10-Year Survival of 771 Rectal Cancer Patients

Journal Paper/Review - Aug 2, 2013

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Citation
Tarantino I, Achermann P, Gueller U, Ulrich A, Schmied B, Horber D, Cerny T, Stanga Z, Warschkow R. Relative Survival is an Adequate Estimate of Cancer-Specific Survival: Baseline Mortality-Adjusted 10-Year Survival of 771 Rectal Cancer Patients. Ann Surg Oncol 2013; 20:3877-2884.
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Type
Journal Paper/Review (English)
Journal
Ann Surg Oncol 2013; 20
Publication Date
Aug 2, 2013
Issn Print
Issn Electronic
1534-4681
Pages
3877-2884
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Brief description/objective

BACKGROUND
The objective of the present investigation is to assess the baseline mortality-adjusted 10-year survival of rectal cancer patients.

METHODS
Ten-year survival was analyzed in 771 consecutive American Joint Committee on Cancer (AJCC) stage I-IV rectal cancer patients undergoing open resection between 1991 and 2008 using risk-adjusted Cox proportional hazard regression models adjusting for population-based baseline mortality.

RESULTS
The median follow-up of patients alive was 8.8 years. The 10-year relative, overall, and cancer-specific survival were 66.5 % [95 % confidence interval (CI) 61.3-72.1], 48.7 % (95 % CI 44.9-52.8), and 66.4 % (95 % CI 62.5-70.5), respectively. In the entire patient sample (stage I-IV) 47.3 % and in patients with stage I-III 33.6 % of all deaths were related to rectal cancer during the 10-year period. For patients with AJCC stage I rectal cancer, the 10-year overall survival was 96 % and did not significantly differ from an average population after matching for gender, age, and calendar year (p = 0.151). For the more advanced tumor stages, however, survival was significantly impaired (p < 0.001).

CONCLUSIONS
Retrospective investigations of survival after rectal cancer resection should adjust for baseline mortality because a large fraction of deaths is not cancer related. Stage I rectal cancer patients, compared to patients with more advanced disease stages, have a relative survival close to 100 % and can thus be considered cured. Using this relative-survival approach, the real public health burden caused by rectal cancer can reliably be analyzed and reported.