RT Journal Article
T1 Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.
A1 Allemani, Claudia
A1 Rachet, Bernard
A1 Weir, Hannah K.
A1 Richardson, Lisa C.
A1 Lepage, Côme
A1 Faivre, Jean
A1 Gatta, Gemma
A1 Capocaccia, Riccardo
A1 Sant, Milena
A1 Baili, Paolo
A1 Lombardo, Claudio
A1 Aareleid, Tiiu
A1 Ardanaz, Eva
A1 Bielska-Lasota, Magdalena
A1 Bolick, Susan
A1 Cress, Rosemary
A1 Elferink, Marloes
A1 Fulton, John P.
A1 Galceran, Jaume
A1 Gózdz, Stanislaw
A1 Hakulinen, Timo
A1 Primic-Zakelj, Maja
A1 Rachtan, Jadwiga
A1 Diba, Chakameh Safaei
A1 Sanchez-Perez, Maria-Jose
A1 Schymura, Maria J.
A1 Shen, Tiefu
A1 Tagliabue, Giovanna
A1 Tumino, Rosario
A1 Vercelli, Marina
A1 Wolf, Holly J.
A1 Wu, Xiao-Cheng
A1 Coleman, Michel P.
K1 Epidemiología
K1 Salud Pública
K1 Neoplasias Colorrectales
AB OBJECTIVES: To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe.DESIGN: A high-resolution study using detailed clinical data on Dukes' stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis.SETTING AND PARTICIPANTS: 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15-99 years) diagnosed with colorectal cancer during 1996-1998.OUTCOME MEASURES: Logistic regression models were used to compare adherence to 'standard care' in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models.RESULTS: The proportion of Dukes' A and B tumours was similar in the USA and Europe, while that of Dukes' C was more frequent in the USA (38% vs 21%) and of Dukes' D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75-99 years) were 70-90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54-56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes' D tumours.CONCLUSIONS: The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.
PB BMJ Publishing Group
YR 2013
FD 2013-09-10
LK http://hdl.handle.net/10668/1599
UL http://hdl.handle.net/10668/1599
LA en
NO Allemani C, Rachet B, Weir HK, Richardson LC, Lepage C, Faivre J, et al. Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study. BMJ Open. 2013; 3(9):e003055
NO Journal Article;
DS RISalud
RD Apr 10, 2025