uu.seUppsala universitets publikasjoner
Endre søk
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study
London Sch Hyg & Trop Med, Canc Survival Grp, Dept Noncommunicable Dis Epidemiol, London, England.
London Sch Hyg & Trop Med, Canc Survival Grp, Dept Noncommunicable Dis Epidemiol, London, England;Univ Bologna, Dept Med & Surg Sci, Alma Mater Studiorum, Bologna, Italy.
London Sch Hyg & Trop Med, Canc Survival Grp, Dept Noncommunicable Dis Epidemiol, London, England.
London Sch Hyg & Trop Med, Canc Survival Grp, Dept Noncommunicable Dis Epidemiol, London, England.
Vise andre og tillknytning
2019 (engelsk)Inngår i: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 20, nr 1, s. 74-87Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background Survival from colorectal cancer has been shown to be lower in Denmark and England than in comparable high-income countries. We used data from national colorectal cancer registries to assess whether differences in the proportion of patients receiving resectional surgery could contribute to international differences in colorectal cancer survival.

Methods In this population-based study, we collected data from all patients aged 18-99 years diagnosed with primary, invasive, colorectal adenocarcinoma from Jan 1, 2010, to Dec 31, 2012, in Denmark, England, Norway, and Sweden, from national colorectal cancer registries. We estimated age-standardised net survival using multivariable modelling, and we compared the proportion of patients receiving resectional surgery by stage and age. We used logistic regression to predict the resectional surgery status patients would have had if they had been treated as in the best performing country, given their individual characteristics.

Findings We extracted registry data for 139457 adult patients with invasive colorectal adenocarcinoma: 12958 patients in Denmark, 97466 in England, 11450 in Norway, and 17583 in Sweden. 3-year colon cancer survival was lower in England (63.9%, 95% CI 63.5-64.3) and Denmark (65.7%, 64.7-66.8) than in Norway (69.5%, 68.4-70.5) and Sweden (72.1%, 71.2-73.0). Rectal cancer survival was lower in England (69.7%, 69.1-70.3) than in the other three countries (Denmark 72.5%, 71.1-74.0; Sweden 74.1%, 72.7-75.4; and Norway 75.0%, 73.1-76.8). We found no significant differences in survival for patients with stage I disease in any of the four countries. 3-year survival after stage II or III rectal cancer and stage IV colon cancer was consistently lower in England (stage II rectal cancer 86.4%, 95% CI 85.0-87.6; stage III rectal cancer 75.5%, 74.2-76.7; and stage IV colon cancer 20.5%, 19.9-21.1) than in Norway (94.1%, 91.5-96.0; 83.4%, 80.1-86.1; and 33.0%, 31.0-35.1) and Sweden (92.9%, 90.8-94.6; 80.6%, 78.2-82.7; and 23.7%, 22.0-25.3). 3-year survival after stage II rectal cancer and stage IV colon cancer was also lower in England than in Denmark (stage II rectal cancer 91.2%, 88.8-93.1; and stage IV colon cancer 23.5%, 21.9-25.1). The total proportion of patients treated with resectional surgery ranged from 47803 (68.4%) of 69867 patients in England to 9582 (81.3%) of 11786 in Sweden for colon cancer, and from 16544 (59.9%) of 27599 in England to 4106 (70.8%) of 5797 in Sweden for rectal cancer. This range was widest for patients older than 75 years (colon cancer 19078 [59.7%] of 31946 patients in England to 4429 [80.9%] of 5474 in Sweden; rectal cancer 4663 [45.7%] of 10195 in England to 1342 [61.9%] of 2169 in Sweden), and the proportion of patients treated with resectional surgery was consistently lowest in England. The age gradient of the decline in the proportion of patients treated with resectional surgery was steeper in England than in the other three countries in all stage categories. In the hypothetical scenario where all patients were treated as in Sweden, given their age, sex, and disease stage, the largest increase in resectional surgery would be for patients with stage III rectal cancer in England (increasing from 70.3% to 88.2%).

Interpretation Survival from colon cancer and rectal cancer in England and colon cancer in Denmark was lower than in Norway and Sweden. Survival paralleled the relative provision of resectional surgery in these countries. Differences in patient selection for surgery, especially in patients older than 75 years or individuals with advanced disease, might partly explain these differences in international colorectal cancer survival.

sted, utgiver, år, opplag, sider
2019. Vol. 20, nr 1, s. 74-87
Emneord [en]
complete mesocolic excision, rectal-cancer, adjuvant chemotherapy, older patients, surgery, diagnosis, radiotherapy, metaanalysis, management, registries
HSV kategori
Identifikatorer
URN: urn:nbn:se:uu:diva-374440DOI: 10.1016/S1470-2045(18)30646-6ISI: 000454901700047PubMedID: 30545752OAI: oai:DiVA.org:uu-374440DiVA, id: diva2:1282255
Tilgjengelig fra: 2019-01-24 Laget: 2019-01-24 Sist oppdatert: 2019-01-24bibliografisk kontrollert

Open Access i DiVA

fulltekst(1258 kB)100 nedlastinger
Filinformasjon
Fil FULLTEXT01.pdfFilstørrelse 1258 kBChecksum SHA-512
7ccaa16155f7f766cb17023c134784ccaf4a158bef0668f2f204eb2174ebe875cbad7dd8c3c175b6b0550225fff9ad2fa822fc2b6ef37ec5c4acaec5173a53e1
Type fulltextMimetype application/pdf

Andre lenker

Forlagets fulltekstPubMed

Personposter BETA

Glimelius, Bengt

Søk i DiVA

Av forfatter/redaktør
Glimelius, Bengt
Av organisasjonen
I samme tidsskrift
The Lancet Oncology

Søk utenfor DiVA

GoogleGoogle Scholar
Totalt: 100 nedlastinger
Antall nedlastinger er summen av alle nedlastinger av alle fulltekster. Det kan for eksempel være tidligere versjoner som er ikke lenger tilgjengelige

doi
pubmed
urn-nbn

Altmetric

doi
pubmed
urn-nbn
Totalt: 105 treff
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf