Looking at Differences in Stage and Treatment of Colorectal Cancers across Italy: A EUROCARE-5 High Resolution Study

Aims and background The high incidence and the estimate of a five-year relative survival of 59% for colorectal cancer in Italy were the main reasons to investigate the management of Italian patients with colorectal cancer diagnosed in the early 2000s. Methods Samples of adult (≥15 years) patients diagnosed in 2003–2005 with a colorectal cancer were randomly selected in 8 Italian population-based cancer registries. The z test was used to evaluate differences in proportions of Dukes stage, patients with at least 12 examined lymph nodes, and of cases treated with curative surgery plus chemotherapy or plus radiotherapy and diagnosed with colon or rectal tumors, respectively. Logistic regression models were used to estimate odds ratios of receiving the selected treatment in each cancer registry, age group and stage category, by anatomical subsite. Results A total of 3,938 colorectal cancer patients were analyzed. About 40% of the cases were over 75 years of age at diagnosis and at Dukes A + B stages. Higher proportions of early stages were found in the northern cancer registries. High percentages of resection with a curative intent were observed in Reggio Emilia (northern Italy), in 15 to 74-year-old patients, and at Dukes B stage. At least 12 lymph nodes were more frequently examined in the north of the country. After adjusting for age and stage, no significant differences were seen in the odds ratios of receiving surgery plus chemotherapy between cancer registries, whereas surgery plus radiotherapy was more frequent in Napoli (southern Italy) and less frequent in Biella (northern Italy). Conclusions Some disparities in staging and treatment of colorectal cancer patients persist across Italy. National oncological plans still need to reduce inequalities in provision and access to proper care.

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Prognostic Significance of Cytokeratin-20 Reverse Transcriptase Polymerase Chain Reaction in Lymph Nodes of Node-Negative Colorectal Cancer Patients

Journal of Clinical Oncology ◽

10.1200/jco.20.4.1049 ◽

2002 ◽

Vol 20 (4) ◽

pp. 1049-1055 ◽

Cited By ~ 45

Author(s):

R. Rosenberg

Keyword(s):

Colorectal Cancer ◽

Polymerase Chain Reaction ◽

Lymph Nodes ◽

Cancer Patients ◽

Prognostic Significance ◽

Cytokeratin 20 ◽

Chain Reaction ◽

Node Negative ◽

Polymerase Chain ◽

Colorectal Cancer Patients

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High Expression of sLex Associated with Poor Survival in Argentinian Colorectal Cancer Patients

The International Journal of Biological Markers ◽

10.5301/jbm.5000060 ◽

2014 ◽

Vol 29 (1) ◽

pp. e30-e39 ◽

Cited By ~ 5

Author(s):

Ariel Zwenger ◽

Martin Rabassa ◽

Sandra Demichelis ◽

Gabriel Grossman ◽

Amada Segal-Eiras ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Normal Mucosa ◽

Poor Survival ◽

Primary Tumors ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Colorectal Cancer Patients

Aim Colorectal cancer (CRC) is one of the most prevalent malignancies in Argentina with 11,043 new cases and 6,596 deaths estimated to have occurred in 2008. The present study was developed to clarify the differential expression of MUC1, MUC2, sLex, and sLea in colorectal cancer patients and their relationship with survival and clinical and histological features. Methods Ninety primary tumor samples and 43 metastatic lymph nodes from CRC patients were studied; follow-up was documented. Twenty-six adenoma and 68 histological normal mucosa specimens were analyzed. An immunohistochemical approach was applied and statistical analysis was performed. Results In tumor samples, MUC1, sLea, and sLex were highly expressed (94%, 67%, and 91%, respectively); also, we found a significantly increased expression of the 3 antigens in primary tumors and metastatic lymph nodes compared with normal mucosa and adenomas. MUC2 was expressed in 52% of both normal mucosa and CRC samples; this reactivity significantly decreased in metastatic lymph nodes (p<0.05). A multiple comparison analysis showed that MUC1 and sLex discriminated among 3 groups: normal, adenoma, and CRC tissues. The increase of sLex expression showed an association with recurrence, and survival analysis showed that a high sLex staining was significantly associated with a poor survival. By multivariate analysis MUC1 inmunoreactivity correlated positively and significantly with tumor size, while MUC2 expression showed the opposite correlation. Conclusions The correlation of sLex overexpression in primary tumors and metastatic lymph nodes, the discrimination among the normal, adenoma, and CRC groups based on sLex expression, as well as its association with recurrence and survival, all suggest a prognostic role of sLex in Argentinian CRC patients.

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Log odds of positive lymph nodes as a prognostic indicator in stage IV colorectal cancer patients undergoing curative resection

Journal of Surgical Oncology ◽

10.1002/jso.23855 ◽

2015 ◽

Vol 111 (4) ◽

pp. 465-471 ◽

Cited By ~ 6

Author(s):

Tsuyoshi Ozawa ◽

Soichiro Ishihara ◽

Eiji Sunami ◽

Joji Kitayama ◽

Toshiaki Watanabe

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Cancer Patients ◽

Curative Resection ◽

Stage Iv ◽

Prognostic Indicator ◽

Stage Iv Colorectal Cancer ◽

Log Odds ◽

Colorectal Cancer Patients ◽

Positive Lymph Nodes

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Variations in the Survival of Adult Cancer Patients in Italy

Tumori Journal ◽

10.1177/030089169708300112 ◽

1997 ◽

Vol 83 (1) ◽

pp. 497-504 ◽

Cited By ~ 24

Author(s):

Gemma Gatta ◽

Eva Buiatti ◽

Ettore Conti ◽

Vincenzo De Lisi ◽

Fabio Falcini ◽

...

Keyword(s):

Cancer Patients ◽

Geographical Area ◽

Central Italy ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Italian Population ◽

Age Class ◽

General Survival ◽

General Improvement

Aims As part of the ITACARE project, the present study analyzed and compared population-based data on the survival of adult cancer patients in Italy, according to sex, age, period of diagnosis and geographical area. Methods Nine Italian population-based cancer registries provided data on all their cancer patients (total 90,431 cases) followed for at least 5 years and diagnosed during the period 1978–1989. About 10% of the Italian population is covered by these registries. The data was analyzed by means of a multivariate model. Results The major findings were that there was a general improvement in 5-year relative survival over the study period (from 33% to 39%) and that there were significant differences in survival between different areas of the country, particularly for cancer sites which respond well to treatment. In general, the area covered by the Ragusa (Sicily) registry was characterized by significantly worse survival than other registry populations. Other important findings were that for all malignant cancer sites 5-year relative survival decreased with age from 50% for the youngest age class (15–44 years) to 27% for the oldest age class (75+ years) and that women have a better prognosis for most cancer sites (overall 5-year relative survival in women 48% vs 32% in men). Conclusions The significant regional differences in survival may reflect unequal provision of care, particularly between northern-central Italy and the south. The reasons for the general survival improvement with time are not completely understood, whereas the marked overall sex difference is related to the fact that the commonest cancer in women (breast cancer) is eminently more treatable than the commonest malignancy in men (lung cancer). The unfavorable trend with increasing age may be due to increasing difficulty in applying complete therapy protocols as general health declines, sometimes in relation to an advanced cancer stage at diagnosis.

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