Duration of symptoms, stage at diagnosis and relative survival in colon and rectal cancer.

In colorectal cancer, the relation between duration of symptoms and stage at presentation and prognosis is not yet settled. All 1263 patients treated for colorectal cancer at Levanger Hospital, 1980-2004, and 2892 patients treated in Norway during 2004 were included. The association between symptom duration as an explanatory variable and tumour stage as a dependent variable was analysed using a proportional odds logistic regression model. Known duration of symptoms was divided into four categories: <1 week, 1-8 weeks, 2-6 months and >6 months. There was an inverse relationship between symptom duration and colon cancer TNM-stage, OR=0.73 (95% CI 0.63-0.84), p<0.001 (Levanger Hospital) and 0.84 (0.75-0.95), p=0.004 (Norway 2004), where the OR is per category of symptom duration. Duration of symptoms were also inversely associated with T-stage, N-stage and M-stage in colon cancer. These relationships were not found for rectal cancer. In colon cancer the relative five-year survival for the four intervals of symptom duration was 44%, 39%, 54% and 66%, p<0.001, in Levanger, 1980-2004, and four-year survival was 46%, 62%, 75% and 74%, p<0.001, in Norway 2004, respectively. For rectal cancer survival was not dependent on symptom duration. In a multivariate analysis of relative survival of patients with colon cancer, duration of symptoms was associated with survival independent of tumour differentiation and TNM-stage. Increasing duration of symptoms was positively associated with less advanced disease and better survival in colon cancer, but not in rectal cancer.

Diabetes mellitus and outcomes of colorectal cancer.

BACKGROUND: Patients with diabetes mellitus have an increased risk of colorectal cancer. However, there is limited information on the outcome for diabetic patients diagnosed with this type of cancer. METHODS: The health records of all 1 194 patients treated for colorectal adenocarcinoma at Levanger Hospital from 1980-2004 were reviewed. Diabetes status and prognostic factors were registered. Primary endpoints were cancer specific survival and overall survival. RESULTS: There were no significant differences between diabetic patients and non-diabetic patients concerning stage, grade, treatment, infective or non-infective postoperative complications, hospital stay, or 30 days mortality after laparotomy. After a curative resection, the estimated 5-year cancer specific survival in 97 diabetic patients was 73% (95% CI 60-87) and 79% (95% CI 75-82) in 1097 non-diabetic patients (not significant). The estimated overall 5-year survival in patients treated with curative intent was 46% (95% CI 33-59) in diabetic patients and 65% (95% CI 62-69) in non-diabetic patients (p<0.001). The diabetic patients were significantly older and more frequently had cardiac diseases. CONCLUSION: Diabetes mellitus did not affect the short-term survival or the cancer specific survival. A shorter overall survival was associated with cardiac diseases and higher age.

Chemotherapy for nonresectable colorectal cancer at a center during 25 years.

BACKGROUND/AIMS: The aims of the present study were to assess overall survival in patients with advanced, nonresectable colorectal cancer from an individual center and to evaluate the effect of successive new chemotherapy regimens during 25 years at that center. METHODOLOGY: The medical journals of all patients with metastastic or locally advanced, nonresectable, colorectal adenocarcinoma treated at Levanger Hospital from 1980 to 2004 were retrospectively analyzed; there were a total of 465 patients. RESULTS: Two hundred patients (43%) received chemotherapy while 265 did not. Estimated overall median months of survival (95% C.I.) were 4.9 (4.2-5.6) with no chemotherapy, 8.2 (5.8-10.6) with 5-FU, 9.6 (7.7-11.5) with 5-FU/LV, 10.7 (1.1-20.3) with Campto based, and 15.2 (4.5-26.0) with Oxaliplatin based regimens (p<0.001, log rank test). In a multivariate analysis, type of chemotherapy regimen and histologic differentiation of the primary tumor were associated with survival, while year of treatment and age was not. Among those who received chemotherapy, this treatment was given in the last 14 days of life in 20% of the patients during 1980-1984 compared to 4.7% during 2000-2006. CONCLUSIONS: As successive new chemotherapy regimens were introduced during the 25 years, increasing overall survival was shown.

Short and long-term survival from gastric cancer. A population-based study from a county hospital during 25 years.

The aim of this study was to evaluate the outcome for gastric cancer patients treated at a medium sized Norwegian hospital. The medical journals of all 356 patients with gastric cancer treated at Levanger Hospital from 1980 to 2004 were retrospectively analysed. Follow-up with regard to survival was complete. The Department of Surgery had treated 277 patients (78%). The resection rate of patients admitted to the Department of Surgery was 56% (154/277), and the total resection rate was 43% (154/356). R0 resection was done in 97 patients (27%), R1 resection in 16 (4%), palliative R2 resection in 41 (12%), other palliative procedures in 59 (17%), and only palliative care was given for 143 (40%) patients. The 30-days postoperative mortality was 2.7% (3/113) after R0 and R1 resections, 4.9% (2/41) after R2 resections, and 24% (14/59) after other palliative procedures. After R0 resections, the estimated overall 5-year survival was 39% (95% C.I. 29-49). After R1 and R2 resections, none survived 5 years and the estimated overall 2-year survival was 12% (95% C.I. 0-27%) and 2% (95% C.I. 0-7%), respectively. Estimated overall 5-year survival was closely related to stage: 91% (95% C.I. 74-100) in stage 1A, 64% (95% C.I. 53-74) in stage 1B, 27% (95% C.I. 10-44) in stage II, 18% (95% C.I. 4-32) in stage IIIA, and none in stages IIIB and IV. Dysphagia, fatigue, weight loss, palpable tumour, ascites and anaemia were related to a bad prognosis. Dyspepsia, vomiting and hematemesis were not related to the prognosis. Symptoms duration > 6 months were related to a better prognosis than short duration of symptoms < 2 months. The results from this hospital are in accordance with previous reports from the Western world.