Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients.

Halfter, K; Schubert-Fritschle, G; Röder, F; Kim, M; Werner, J; Belka, C; Wolff, H; Agha, A; Fuchs, M; Friess, H; Combs, S; Häussler, B; Engel, J; Schlesinger-Raab, A

doi:10.1016/j.canep.2023.102440

2023

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Titel:: Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients.
Dokumenttyp:: Journal Article
Autor(en):: Halfter, K; Schubert-Fritschle, G; Röder, F; Kim, M; Werner, J; Belka, C; Wolff, H; Agha, A; Fuchs, M; Friess, H; Combs, S; Häussler, B; Engel, J; Schlesinger-Raab, A
Abstract:: BACKGROUND: Rectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohort of patients. METHODS: 20 281 non-metastasized cases retrieved from the Munich Cancer Registry database were divided into three time periods corresponding to before (1988-1997), partial (1998-2007), and full implementation (2008-2019) of clinical advances. Early-onset (<50 yrs.), middle-aged, elderly patient subgroups (> 70 yrs.) were compared. The overall effectiveness of evidence-based guideline adherence was also examined. RESULTS: Median survival improved by 1.5 yrs. from the first to the last time period. Relative survival increased from 74.9% (5-yr 95%CI[73.3 - 76.6]) to 79.2% (95%CI[77.8 - 80.5]). The incidence of locoregional recurrences was reduced dramatically by more than half (5-yr 17.7% (95%CI[16.5 - 18.8]); 6.7% (95%CI[6.1 - 7.3])). Gains in 5-yr relative survival were limited to early-onset and middle-aged patients with no significant improvement seen in elderly patients (Female 68.6% [63.9 - 73.3] to 67.6% [64.0 - 71.2]; Male 71.7% [65.9 - 77.4] to 74.0% [70.8 - 77.2]). CONCLUSIONS: Real-world evidence suggests that recent treatment advances have lead to an increase in prognosis for rectal cancer patients. However, more effort should be made to improve the implementation of new developments in elderly patients. Especially considering, that these cases represent a growing majority of diagnosed patients.
Zeitschriftentitel:: Cancer Epidemiol
Jahr:: 2023
Band / Volume:: 86
Volltext / DOI:: doi:10.1016/j.canep.2023.102440
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/37572415
Print-ISSN:: 1877-7821
TUM Einrichtung:: 591; Klinik und Poliklinik für Chirurgie (Prof. Friess); Klinik und Poliklinik für RadioOnkologie und Strahlentherapie (Prof. Combs)
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