The correlation between a family history of colorectal cancer and survival of patients with colorectal cancer

Abstract

The purpose was to analyze survival of patients with colorectal cancer and a positive family history for colorectal cancer in first degree relatives compared with those with no such family history and to determine whether differences in survival could be explained by known clinico-pathological factors. During 2000-2003, 318 consecutive patients with colorectal cancer answered a written questionnaire about their family history for colorectal cancer. During a 6-year follow-up, recurrences and survival were registered. Thirty-one (10%) patients had a first-degree relative with colorectal cancer, moreover two patients fulfilled the criteria of hereditary non-polyposis colorectal cancer and were excluded. Patients with a first-degree relative with colorectal cancer had better survival and lower risk for recurrences compared to those with no relatives with colorectal cancer. In a multivariate analysis including age, gender, stage of disease, tumor differentiation, vascular invasion and family history, patients with first-degree relatives with colorectal cancer had lower risks for death (RR 0.37; 95% CI 0.17-0.78) and death from cancer (RR 0.25; 95% CI 0.08-0.80), compared to those with a no relative with colorectal cancer. The differences were seen in patients with colon cancer but not rectal cancer. Family history for colorectal cancer in a first-degree relative is an individual prognostic factor in patients with colon cancer and could not be explained by known clinico-pathological factors. The value of family history taking in patients with colon cancer is therefore not only to identify families with hereditary colorectal cancer, but also to add information to the prognosis of the patients.

Survival in familial colorectal cancer: a Danish cohort study

“…In five of these, a positive family history of CRC was associated with better survival in CRC patients [6,9,[11][12][13][14]. Two studies indicated higher mortality [8,15], and six studies found no association between CRC family history and survival in CRC patients [5,7,9,10,16,17], although Slattery et al [7] did find a higher mortality for men under age 55 with a positive family history of CRC.…”

“…Two studies indicated higher mortality [8,15], and six studies found no association between CRC family history and survival in CRC patients [5,7,9,10,16,17], although Slattery et al [7] did find a higher mortality for men under age 55 with a positive family history of CRC. Only one small study (N = 318) [12] verified the FDR's cancer diagnoses as reported by the patients, the rest relied solely on self-report of cancer. At least two studies on accuracy of self-reported family history have found that CRC diagnoses in relatives often are underreported [26,27], which stresses that the use of selfreported cancer among family members can cause misclassification.…”

“…Three studies [12,14,16] did this by excluding patients with self-reported family history fulfilling the Amsterdam criteria. Two studies found a better survival in CRC patients with a family history of CRC: RR = 0.37 (0.17, 0.78) and HR 0.760 (0.580, 0.997), respectively [12,14]. Phipps et al [17] excluded patients with a detected germline mutation in one of the four MMR genes.…”

“…Whether family history of CRC affects survival of CRC patients in general has been investigated in numerous studies with conflicting results [5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Risk Factors for Colorectal Cancer

“…Interestingly, family history has also been associated with improved survival after treatment for CRC. In one Swedish study, patients with one first-degree relative with CRC were 75% less likely to succumb to their disease [9]. This is somewhat counter-intuitive to what is expected, as patients with a positive family history should be more prone to developing polyps and metachronous cancers.…”