Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients

Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients

Rectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohor...

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Bibliographic Details
Published in:Cancer epidemiology Vol. 86; p. 102440
Main Authors: Halfter, K., Schubert-Fritschle, G., Röder, F., Kim, M., Werner, J., Belka, C., Wolff, H., Agha, A., Fuchs, M., Friess, H., Combs, S., Häussler, B., Engel, J., Schlesinger-Raab, A.
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-10-2023
Elsevier Limited
Subjects:
Age
Cancer
Cancer therapies
Chemotherapy
Classification
Cohort analysis
Cohort study
Colorectal cancer
Disease
Effectiveness
Elderly cancer patients
Epidemiology
Histology
Image resolution
Lymphatic system
Medical diagnosis
Medical prognosis
Metastasis
Observational studies
Older people
Pathology
Patients
Prognosis
Radiochemotherapy
Rectal cancer
Rectum
Subgroups
Survival
Total mesorectal excision
Tumors
Total mesorectal excision
Elderly cancer patients
Rectal cancer
Cohort study
Radiochemotherapy
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Summary:Rectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohort of patients. 20 281 non-metastasized cases retrieved from the Munich Cancer Registry database were divided into three time periods corresponding to before (1988–1997), partial (1998–2007), and full implementation (2008–2019) of clinical advances. Early-onset (<50 yrs.), middle-aged, elderly patient subgroups (> 70 yrs.) were compared. The overall effectiveness of evidence-based guideline adherence was also examined. Median survival improved by 1.5 yrs. from the first to the last time period. Relative survival increased from 74.9% (5-yr 95%CI[73.3 – 76.6]) to 79.2% (95%CI[77.8 – 80.5]). The incidence of locoregional recurrences was reduced dramatically by more than half (5-yr 17.7% (95%CI[16.5 – 18.8]); 6.7% (95%CI[6.1 – 7.3])). Gains in 5-yr relative survival were limited to early-onset and middle-aged patients with no significant improvement seen in elderly patients (Female 68.6% [63.9 – 73.3] to 67.6% [64.0 – 71.2]; Male 71.7% [65.9 – 77.4] to 74.0% [70.8 – 77.2]). Real-world evidence suggests that recent treatment advances have lead to an increase in prognosis for rectal cancer patients. However, more effort should be made to improve the implementation of new developments in elderly patients. Especially considering, that these cases represent a growing majority of diagnosed patients. •Real-world cohort of rectal cancer patients spanning three decades highlights the effectiveness of rectal cancer advances.•Partial implementation of mesorectal excision and radiochemotherapy significantly lowered risk of locoregional recurrences.•Subgroup analysis show that relative survival did not improve in elderly patients.•Guideline non-adherence potentially associated with unchanging prognosis in elderly patients.
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ISSN:1877-7821
1877-783X
DOI:10.1016/j.canep.2023.102440