Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study / 한국역학회지

OBJECTIVES: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran. METHODS: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates. RESULTS: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model. CONCLUSIONS: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.

Cancer incidence in golestan province: report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Golestan Province, at the western end of the Asian esophageal cancer [EC] belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry [GPCR]. The GPCR collected data from newly diagnosed [incident] cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer [IARC]. Age-standardized incidence rates [ASR] of cancers were calculated using the 2000 world standard population. From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean [SD] age was 55.5 [18.6] years, and 54% were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach [ASR:30.7], esophagus [24.3], and lung [15.4] were the most common cancers in males. In females, breast cancer [ASR:26.9] was followed by malignancies of the esophagus [19.1] and stomach [12.4]. The diagnosis of cancer was based on histopatho-logical reports in 71% and on death certificate only in 9% of cases. The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase