Dataset Information

The impact of screening on the survival of colorectal cancer in Shanghai, China: a population based study.

ABSTRACT:

Background

Shanghai is one of the earliest cities in developing countries to introduce an organized colorectal screening program for its residents to fight against the rising disease burden of colorectal cancer (CRC). This study aims to investigate the impact of the Shanghai screening program implemented in 2013 on the survival rates of CRC patients.

Methods

We calculated up to 5-year survival rates for 18,592 CRC patients from a representative district of Shanghai during 2002-2016, using data from the Shanghai Cancer Registry. We performed joinpoint regressions to examine temporal changes in the trends of the CRC survival rates. We then conducted Kaplan-Meier and Cox proportional hazards modelling to study the association of the survival rates with screening behaviors of the patients. In all the model specifications, we took into account the gender, age and TNM stage at diagnosis, and level of treatment hospital of the patients.

Results

We find that the annual percentage changes of the survival rates increased faster after somewhere around 2013, however, the differential trends were not significant. Results from the Cox multivariate regression analysis suggest that patients who did not participate in the screening program showed significantly lower cancer-specific survival (hazard ratio (HR)?=?1.46; 95% confidence interval (CI): 1.12-1.91) and all-causes survival (HR?=?1.37; 95% CI: 1.05-1.77), compared to those who did. Among program participants, delayed colonoscopy was associated with poor cancer-specific survival (hazard ratio (HR)?=?2.93; 95% confidence interval (CI): 1.64-5.23) and all-causes survival (HR?=?3.29; 95% CI: 1.85-5.84).

Conclusion

Screening participation and high level of colonoscopy compliance can improve the survival of CRC participants.

SUBMITTER: Li X

PROVIDER: S-EPMC6664771 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

The impact of screening on the survival of colorectal cancer in Shanghai, China: a population based study.

Li Xiaopan X Zhou Yi Y Luo Zheng Z Gu Yi'an Y Chen Yichen Y Yang Chen C Wang Jing J Xiao Shaotan S Sun Qiao Q Qian Mengcen M Zhao Genming G

BMC public health 20190729 1

<h4>Background</h4>Shanghai is one of the earliest cities in developing countries to introduce an organized colorectal screening program for its residents to fight against the rising disease burden of colorectal cancer (CRC). This study aims to investigate the impact of the Shanghai screening program implemented in 2013 on the survival rates of CRC patients.<h4>Methods</h4>We calculated up to 5-year survival rates for 18,592 CRC patients from a representative district of Shanghai during 2002-201 ...[more]

PMID: 31357981

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Project description:This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0-2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I-IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.

Dataset Information

The impact of screening on the survival of colorectal cancer in Shanghai, China: a population based study.

Background

Methods

Results

Conclusion

Publications

The impact of screening on the survival of colorectal cancer in Shanghai, China: a population based study.

Similar Datasets

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