Factors predictive of an advanced stage of colorectal cancer at presentation – a bi‐national study

Abstract

Aim Identifying elements associated with advanced colorectal cancer (CRC) stage may inform understanding of whether advanced disease is a corollary of access to healthcare or tumour biology and in turn allow the use of targeted screening and awareness programmes. The aim of this study was to identify factors that predict advanced stage of CRC at presentation in Australia and New Zealand. Method This was a cross-sectional registry study sourced from the prospectively maintained Binational Colorectal Cancer Audit database of Australia and New Zealand. The primary outcome was stage as defined by the TNM system with associations drawn to demographic and perioperative variables. Results In total, 25 282 separate cancers were included. Univariate analysis found younger age, treatment at a public facility, increasing American Society of Anesthesiologists (ASA) grade, more distal tumours, and less recent year of surgery to all be associated with more advanced disease; sex and presentation at a rural vs urban hospital had no bearing on this outcome. Logistic regression identified younger age (< 60 years vs > 80 years: OR 1.96; 95% CI 1.80-2.14; P = 0.002), treatment at a public vs private hospital (OR 1.21; 95% CI 1.14-1.28; P < 0.001), increasing ASA grade (ASA4 vs ASA1: OR 1.37; 95% CI 1.17-1.59, P < 0.001) and more distal tumours (mid-low rectal vs right colon tumours: OR 1.52; 95% CI 1.41-1.64; P < 0.001) to be independent predictors of nodal or metastatic disease at presentation. Conclusion Younger age, increasing ASA grade, more distal tumours, and treatment at a public rather than private facility are independently associated with the presence of nodal or distant CRC metastases at diagnosis.

Factors associated with advanced colorectal cancer differ between young and older adults in England: a population‐based cohort study

“…The negative association between age and stage at presentation is well described, and was again demonstrated in this study for both proximal and distal tumours [21,25]. Reasons for advanced stage presentation in young adults remain unclear, despite the increased prevalence of hereditary tumours in this group [30].…”

“…Advanced stage presentation is associated with worse survival outcomes, with 5-year net survival in England ranging from 10.3% in Stage IV disease to 91.7% in Stage I disease [20]. Population-based studies in other nations with a high HDI have shown that younger age, social deprivation and Black ethnicity are associated with advanced stage CRC [21][22][23][24][25], but demographic risk factors have not been explored in detail and it is unknown whether these risk factors differ between young and older adults. In the UK, there is scant evidence regarding the association between demographic factors, such as socioeconomic status (SES) and ethnicity, and advanced stage presentation due to a lack of complete data in nationally curated cancer registries until recently [26].…”

Improving Global Surgical Oncology Benchmarks: Defining the Unmet Need for Cancer Surgery in Ghana

“…In addition to prevalence of disease, appropriateness of surgical care in cancer is dependent on differences in patient presentation as well as availability of treatment. In a cohort of colorectal cancer patients in Ghana, only 8% presented with stage III or less disease, as opposed to nearly 90% of patients in New Zealand [8, 31]. Advanced stage presentation is well‐described in SSA and other LMICs [8, 32, 33].…”