Survival and prognostic factors of non metastatic rectal adenocarcinoma: Analytic multifactor review of 91 cases

Abstract

and gender to gain more insight into tailored risk prediction and communication of risk to general practitioners (GPs) and/or participants. Methods: In this retrospective study, data was used of 57,421 participants who underwent a colonoscopy after a positive FIT in the Flemish CRC screening programme between October 2013 until July 2016. Analyses were performed with multinomial logistic regression to predict the probability of normal or noncancerous lesions, precancerous lesions, in situ or invasive cancers. Additionally, odds ratios (OR) were established to visualize the magnitude of the differences between risk profiles within a population with positive FIT, based upon a combination of the quantitative FIT, age and gender. Results: The amount of false positive FIT results followed up by colonoscopy is $27%, where $20% are not followed up at all by colonoscopy within 6 months after a positive FIT. Based on our risk profile calculation, we found a significant difference between the risk of having a normal outcome, a precancerous lesion, an in situ or an invasive cancer. For example, the detection of invasive cancer was 58 (OR) times more likely in a male of 74 years old with a FIT result of ! 1,000 ng/ml compared to a woman of 56 years old with a FIT result of 75 ng/ml. Conclusion: The differences in precancerous lesions or CRC according to our calculated risk profiles, justifies an approach where participants with a positive FIT are not all treated in the same way, based on a binary FIT. Participants and/or their GPs should be informed about individual risks. This will promote informed decision to an extent where participants and/or professionals can make decisions on follow-up. How to communicate this personalised information to participants needs to be discussed and tested. Contrary to the participant, professionals such as GPs should be provided with extra insight in the risk differences per patient, which supports their clinical decision making. The approach above could be extended by adding simple risk factors such as BMI, diet, alcohol intake, family history etc., creating the opportunity to more accurately discriminate between participants with a normal outcome, precancerous lesion, in situ or invasive cancer. Colonoscopy follow up based upon the quantitative FIT, combined with age, gender and additional risk factors instead of upon a binary FIT result only, will probably increase accuracy.

Left-Sided Colon Cancer and Right-Sided Colon Cancer: Are They the Same Cancer or Two Different Entities?

“…The most common poor prognostic factor in all series is the low degree of differentiation compared to other histological types. It is found in about 34% of patients [28,29]. In our series, we had a low rate of poorly differentiated adenocarcinoma (2.40%).…”

“…It increased by 120% between stage II and stage III and reached 900% between stage III and stage IV. In the study by Arfa et al [29], stage IV had the lowest two-year survival rate (22.7%), while stages I and II had a better two-year survival rate (85.3%). Survival was reduced in patients with a right-sided colon tumor classified as stage III and IV in the study by Hu et al [30] (66.1% vs. 75.4%, p = 0.010).…”

“…According to Helvaci et al [25], the five-year survival rate for patients under the age of 75 was 58% and 32% for patients over the age of 75, with a significant difference. According to Arfa et al [29], there is no significant difference in survival among different age groups. Meguid et al [27] found that the risk of mortality increases by 3.6% each year (hazard ratio (HR) = 1.150).…”

“…According to Meguid et al [27], patients treated for right-sided colon cancer have a 4.2% higher risk of mortality compared to those treated for left-sided colon cancer (HR = 1.042, p = 0.001). However, there are some studies, such as that of Arfa et al [29], which concluded the opposite. In our series, overall survival was better for left-sided colon cancers, although the finding was not significant.…”

“…Perineural invasion is considered an independent risk factor for locoregional recurrence in colon cancer [25]. Some studies did not report a difference between right-sided colon cancer and left-sided colon cancer regarding the presence of perineural invasion, whereas others reported a higher rate in patients with right-sided colon cancer (p = 0.05) [27,29]. For our population, perineural invasions were more prevalent in the right-sided colon cancer group (p = 0.005).…”