Prevalence of anaemia at diagnosis of colorectal cancer: assessment of associated risk factors.

BACKGROUND/AIMS: The aim of this study was to report the prevalence of anaemia in patients with cancer located in different anatomical segments of the colon and rectum and to assess possible risk factors for this anaemia. METHODOLOGY: The study included 1189 patients referred during 1980-2004 with a colorectal adenocarcinoma. Data were obtained from hospital records and from the Norwegian Cancer Registry. Risk factors for anaemia were analyzed in multivariable logistic regression analysis. The WHO definition of anaemia was used. RESULTS: The prevalence of anaemia diminished gradually and linearly as the location of the tumours was more distal towards the rectum. Anaemia was found in 74.7% (215/288) of the patients with cancer in the coecum or ascending colon, 57.1% (48/84) in the transverse colon, 40.0% (180/300) in the sigmoid and 30.5% (114/374) in the rectum. In the multivariable analysis, age, location of the tumour and T-stage remained associated with anaemia, whereas the histological differentiation of the tumour, N-stage, M-stage, period of admission, duration of symptoms and rectal bleeding were not. CONCLUSIONS: Anaemia was common, especially in patients with proximal colon cancer. T-stage but not N-stage or M-stage was associated with anaemia.

Violation of treatment guidelines -- hazard for rectal cancer patients.

AIM: The aim of this study was to evaluate temporal trends in treatment and outcome in rectal cancer diagnosed during 1980-2004 at Levanger Hospital. MATERIALS AND METHODS: A protocol for prospective registration of rectal cancer treated with total mesorectal excision including operative strategy, radiotherapy and surveillance was established at Levanger Hospital in 1980. In this study, all rectal cancer patients treated during 1980-2004 were included. RESULTS: More patients received preoperative radiotherapy during 2000-2004, but otherwise there were no significant differences in presentation or treatment during 1980-2004. The 5-year local recurrence rate after resection with curative intent was 4.5% (0-9.7), 18.7% (10.3-27.1) and 2.2% (0-6.7) in 1980-1989, 1990-1999 and 2000-2004 (p = 0.006), respectively. Out of a total of 23 cases of local recurrence, treatment guidelines, mainly with regard to radiotherapy, were violated in 19 cases. The 5-year overall survival after resection with curative intent was 65% (95% confidence interval [CI] 55-76) during 1980-1989, 58% (49-68) in 1990-1999 and 71% (59-83) in 2000-2004 (n.s). The 5-year relative survival was 83% (95% CI 69-95) during 1980-1989, 71% (59-81) in 1990-1999 and 84% (69-98) in 2000-2004 (n.s). CONCLUSION: Rectal cancer patients experienced excellent outcomes in the period 1980-1989 and 2000-2004. Due to violations of treatment guidelines, the rate of local recurrence was much too high in the period 1990-1999. This article illustrates the importance of continuous quality assurance in the treatment of rectal cancer to maintain optimized outcomes for the patients.

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.

[Open surgery of abdominal aortic aneurysm]. / Apen kirurgi for abdominale aortaaneurismer.

BACKGROUND: We wanted to evaluate the results after open surgical treatment of abdominal aortic aneurysm. MATERIAL AND METHODS: We present a retrospective survey of 581 patients operated for infrarenal abdominal aortic aneurysm at the Tromsø University Hospital from 1980 through 1998. RESULTS: The number of elective operations increased from two in 1980 to 18 in 1998. The frequency of conditions regarded as co-morbidity increased during the observed time period. Mean body mass index for electively operated men increased from 24.2 in 1980-84 to 26.1 in 1995-98 (p < 0.01). Mean aneurysms diameter of those operated electively was 60 mm. The operative (30 days) mortality rate was 7.6% for those operated electively, 9.8% for those with impending rupture, and 40% for those with ruptured aneurysm. INTERPRETATION: We find these results comparable with those presented in other reports.