Bridget Robinson1, Frank Frizelle, Michelle Dickson, Chris Frampton. 1. Department of Oncology, Canterbury District Health Board, Christchurch Hospital and the Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand. BridgetR@cdhb.govt.nz
Abstract
AIM: To compare clinicopathological variables, management, and outcome of two cohorts of unselected patients treated for colorectal cancer (CRC) at Christchurch Hospital, New Zealand in 1993-94 and 1998-99. METHODS: Retrospective review from hospital discharge codes, oncology referral database, and histology database. Data was stored in a Microsoft Access database. RESULTS: 356 patients in 1993-94 and 317 patients in 1998-99 had a confirmed diagnosis of adenocarcinoma of the colon or rectum. At the minimum follow-up time of 42 months, 54% (40% of CRC) of the 356 patients in the first cohort, and 36% (26% of CRC) of the 317 patients in the second cohort had died. The Kaplan-Meier survival curves showed significant improvement in 1998-99 overall, as well as for Dukes stages A plus B, stage C, and stage D disease. Computed tomography (CT) scan-staging increased from 11.3% to 62.8%. On multivariate analysis, cohort, stage, vascular/lymphatic invasion, and elective surgery were independent prognostic factors for disease-specific mortality. Over the 5 years (1993-94 to 1998-99), surgery by consultant increased from 44% to 82%, adjuvant chemotherapy for Dukes stage C increased from 21% to 45%, and chemotherapy for metastatic disease increased from 2.4% to 23% of stage D and from 2.5% to 36.5% of those patients who developed metastases. CONCLUSION: The improvement in outcome is attributed to more specialised surgery, more frequent CT scan staging, and greater use of chemotherapy.
AIM: To compare clinicopathological variables, management, and outcome of two cohorts of unselected patients treated for colorectal cancer (CRC) at Christchurch Hospital, New Zealand in 1993-94 and 1998-99. METHODS: Retrospective review from hospital discharge codes, oncology referral database, and histology database. Data was stored in a Microsoft Access database. RESULTS: 356 patients in 1993-94 and 317 patients in 1998-99 had a confirmed diagnosis of adenocarcinoma of the colon or rectum. At the minimum follow-up time of 42 months, 54% (40% of CRC) of the 356 patients in the first cohort, and 36% (26% of CRC) of the 317 patients in the second cohort had died. The Kaplan-Meier survival curves showed significant improvement in 1998-99 overall, as well as for Dukes stages A plus B, stage C, and stage D disease. Computed tomography (CT) scan-staging increased from 11.3% to 62.8%. On multivariate analysis, cohort, stage, vascular/lymphatic invasion, and elective surgery were independent prognostic factors for disease-specific mortality. Over the 5 years (1993-94 to 1998-99), surgery by consultant increased from 44% to 82%, adjuvant chemotherapy for Dukes stage C increased from 21% to 45%, and chemotherapy for metastatic disease increased from 2.4% to 23% of stage D and from 2.5% to 36.5% of those patients who developed metastases. CONCLUSION: The improvement in outcome is attributed to more specialised surgery, more frequent CT scan staging, and greater use of chemotherapy.
Authors: Pragya A Dang; Mannudeep K Kalra; Michael A Blake; Thomas J Schultz; Markus Stout; Elkan F Halpern; Keith J Dreyer Journal: J Digit Imaging Date: 2008-06-10 Impact factor: 4.056