Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study

Abstract

OBJECTIVESWe aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran.METHODSWe used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates.RESULTSOut of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model.CONCLUSIONSColorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.

An Overview of Clinical and Pathological Characteristics and Survival Rate of Colorectal Cancer in Iran

“…Accordingly, by excluding the patients with unknown staging status, the mean proportion of the patients with stage 0-I was 9%. The mean values for stages II, III, and IV were 39%, 36%, and 16%, respectively (11,13,15,19,20,24,29,31,32,37).…”

“…In addition, the median overall survival in 5 studies with 4746 patients was 55.2 months (range: 42-94.5). Besides, the average 1-, 2-, 3-, 4-, 5-, 10-, and 15-year overall survival rates were 85.9%, 74%, 64.9%, 55.3%, 52.5%, 47.9%, and 25.9%, respectively (11,26,29,(31)(32)(33)(34)(36)(37)(38)(39) (Table 3). …”

“…By adding the rectosigmoid junction to rectal primary site, the mean proportion of the rectum as the primary site increased to 42%. Only 4 studies, including 7561 patients provided a detailed information regarding the sublocation of colon primary site as follows: Sigmoid colon 43%, ascending clon 21%, cecum 21%, descending colon 12%, and transverse colon 3% (11,13,15,16,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Out of the scope of the study (n = 21)a Eligible articles for review (n=27) a, Screening and diagnostic methods and colorectal polyps were the most frequent in this category.…”

Overview of Cancer Registration Research in the Asian Pacific from 2008-2013

“…Iran overall ASR in the four years period was 38.0 per 100,000 and was higher for men compared women (Safaee et al, 2012). Colorectal cancer occurs at a younger age among people living in Golestan province, with a high proportion of patients presenting with late stage (Aryaie et al, 2013). In Kerman, the trend in females is increase by 15% and in males by 7% by year 2016 (Roya and Abbas, 2013).…”

Preferences for Colorectal Cancer Screening Tests: Differences Between Insured and Uninsured Beneficiaries of Iranian Health Transformation Plan

“…Moreover, all costs of CRC screening tests are not covered by these schemes for all individuals. Therefore complementary health insurance might play an important role (15)(16)(17)(18). The existence of an insurance coverage is one of the main factors affecting the people preferences for choosing the various types of health services, especially the preventive services (11,12).…”