Improvements in population-based survival of patients presenting with metastatic rectal cancer in the south of the Netherlands, 1992-2008

Abstract

We analysed population-based treatment and survival data of patients who presented with metastatic rectal cancer. All patients diagnosed with primary synchronous metastatic rectal cancer between 1992 and 2008 in the Eindhoven Cancer Registry area were included. Date of diagnosis was divided into three periods (1992-1999, 2000-2004, 2005-2008) according to the availability of chemotherapy type. We assessed treatment patterns and overall survival according to period of diagnosis. The proportion of patients diagnosed with stage IV disease increased from 16% in 1992-1999 to 20% in 2005-2008 (P < 0.0001). Chemotherapy use increased from 5% in 1992 to 61% in 2008 (P < 0.0001). Resection rates of the primary tumour decreased from 65% in 1992 to 27% in 2008 (P < 0.0001), while metastasectomy rates remained constant since 1999 (9%). Median survival increased from 38 weeks (95% confidence interval (CI) 32-44) in 1992-1999 to 53 weeks (95% CI 48-61) in 2005-2008. Among patients not receiving chemotherapy median survival remained approximately 30 weeks. Multivariable analysis confirmed the lower risk of death among patients diagnosed in more recent years. Increased use of chemotherapy went together with improved median survival among patients with metastatic rectal cancer in the last two decades. Stage migration as an effect of more effective imaging procedures is likely to be partly responsible for this improved survival.

Fig. 1

Trend in treatment of patients with rectal cancer and synchronous metastases in the south of the Netherlands, 1992–2006. a Chemotherapy and resection (black line Chemotherapy, grey line Resection of primary tumour, dashed grey line Metastasectomy). b Radiotherapy (black line Radiotherapy without resection (primary tumour), grey line pre- or postoperative radiotherapy (primary tumour), dashed grey line radiotherapy (metastases))

Fig. 2

Crude survival (in weeks) of patients with rectal cancer and synchronous metastases in the south of the Netherlands, by period of diagnosis. dashed grey line 1992–1999, grey line 2000–2004, black line 2005–2008