Background
The reported outcomes of locoregionally recurrent colon cancer (LRCC) are poor, but the literature about LRCC is scarce and aged. Recent population-based studies to provide current insight ...into LRCC are warranted. This study aimed to provide an overview of the incidence, risk factors, treatment, and overall survival (OS) of patients with LRCC after curative resection of stage I–III primary colon cancer.
Methods
Data on disease recurrence were collected for all patients with a diagnosis of non-metastasized primary colon cancer in the Netherlands during the first 6 months of 2015. Patients who underwent surgical resection (N = 3544) were included in this study. The 3-year cumulative incidence, risk factors, treatment, and OS for patients with LRCC were determined.
Results
The 3-year cumulative incidence of LRCC was 3.8%. Synchronous distant metastases (LRCC-M1) were diagnosed in 62.7% of the patients. The risk factors for LRCC were age of 70 years or older, pT4, pN1-2, and R1-2. Adjuvant chemotherapy was associated with a decreased risk of LRCC for high-risk stage II and stage III patients hazard ratio (HR), 0.47; 95% confidence interval (CI) 0.31–0.93. The median OS for the patients with LRCC was 13.1 months (95% CI 9.1–18.3 months). Curative-intent treatment was given to 22.4% of the LRCC patients, and the subsequent 3 years OS was 71% (95% CI 58–87%). The patients treated with palliative treatment and best supportive care showed 3-year OS rates of 15% (95% CI 7.0–31%) and 3.7% (95% CI 1.0–14%), respectively.
Conclusions
The cumulative incidence of LRCC was low, and adjuvant chemotherapy was associated with a decreased risk for LRCC among targeted patients. Curative-intent treatment was given to nearly 1 in 4 LRCC patients, and the OS for this group was high.
Recent experimental and epidemiological studies have suggested that beta‐blocker use might be associated with better cancer prognosis, but results were inconclusive and only few studies have ...investigated the association specifically for colorectal cancer (CRC) patients. We investigated this hypothesis using a linked dataset of the Eindhoven area of the Netherlands Cancer Registry and the PHARMO record linkage, including patients diagnosed with CRC between 1998 and 2011. Eligible patients were matched on propensity scores to control for potential confounders such as socio‐demographic factors, comorbidity, cancer treatment and use of other medications. Controls were subsequently restricted to active comparators. The association between pre‐diagnostic and time‐dependent post‐diagnostic beta‐blocker use and overall survival was estimated using Cox proportional hazard regression models. Subgroup analyses by cancer site and stage and by beta‐blocker type were conducted. Of 8,100 CRC patients with a median follow‐up of 6.6 years, 1,813 (22%) used beta‐blockers prior to diagnosis. In multivariate analysis, we observed no significant association in overall mortality for pre‐diagnostic hazard ratio 1.07, 95% confidence interval (0.96‐1.19) and post‐diagnostic 1.10 (0.98‐1.23) beta‐blocker use, respectively. Analyses by beta‐blocker type, by cancer site, cancer stage and by cumulative dose showed no significant survival improvements for beta‐blocker users. However, there was a significant association between cumulative duration of use of 1‐12 months and increased overall mortality 1.20 (1.03‐1.39). Thus, our results do not support the hypothesis of a beneficial effect of pre‐ or post‐diagnostic beta‐blocker intake on CRC prognosis, neither for specific patient subgroups nor for specific types of beta‐blockers.
What's new?
Stress reactions mediated by the sympathetic nervous system are thought to contribute to certain aspects of cancer. Hence, the possibility of diminishing sympathetic activity through the use of beta‐blockers has drawn significant interest in cancer therapeutics. Here, beta‐blocker use was examined for impacts on survival among colorectal cancer (CRC) patients. No significant benefits were found for pre‐ or post‐diagnostic (time‐dependent) beta‐blocker use. There also were no significant subgroup effects by beta‐blocker type, histology, cumulative dose, or duration of use, indicating that beta‐blockers have no potential survival benefits in CRC.
Background
Diffuse type adenocarcinoma and, more specifically, signet ring cell carcinoma (SRCC) of the stomach and gastroesophageal junction (GEJ) have a poor prognosis and the value of neoadjuvant ...chemo(radio)therapy (nCRT) is unclear.
Methods
All patients who underwent surgery for diffuse type gastric and GEJ carcinoma between 2004 and 2015 were retrospectively included from the Netherlands Cancer Registry. The primary outcome was overall survival after surgery. Kaplan–Meier curves were plotted. Furthermore, multivariable Poisson and Cox regressions were performed, correcting for confounders. To comply with the Cox regression proportional hazard assumption, gastric cancer survival was split into two groups, i.e. <90 days and >90 days, postoperatively by adding an interaction variable.
Results
Analyses included 2046 patients with diffuse type cancer: 1728 gastric cancers (50% SRCC) and 318 GEJ cancers (39% SRCC). In the gastric cancer group, 49% received neoadjuvant chemotherapy (nCT) and 51% received primary surgery (PS). All-cause mortality within 90 days postoperatively was lower after nCT (hazard ratio HR 0.29, 95% confidence interval CI 0.20–0.44;
p
< 0.001). Also after 90 days, mortality was lower in the nCT group (HR for the interaction variable 2.84, 95% CI 1.87–4.30,
p
< 0.001; total HR 0.29*2.84 = 0.84). In the GEJ group, 38% received nCT, 22% received nCRT, and 39% received PS. All-cause mortality was lower after nCT (HR 0.63, 95% CI 0.43–0.93;
p
= 0.020) compared with PS. The nCRT group was removed from the Cox regression analysis since the Kaplan–Meier curves of nCRT and PS intersected. The results for gastric and GEJ carcinomas were similar between the SRCC and non-SRCC subgroups.
Conclusion
For gastric and GEJ diffuse type cancer, including SRCC, nCT was associated with increased survival.
Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in ...patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015‐2018) or patients with metachronous metastases after primary non‐metastatic diagnosis in 2015‐2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04‐1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12‐1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.
Patients with metastases limited to the supraclavicular lymph nodes had a better survival time compared with patients with a cT4b tumor (without metastases) and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.
Previous studies showed that the incidence of early-onset colorectal cancer (EO-CRC, diagnosis <50 years) is rising in Western countries. Additionally, young patients present with more advanced ...disease. Integrated nationwide assessment of epidemiologically and clinically relevant trends would provide more insight into this specific group of patients with CRC. We aimed to provide an analysis of trends in age- and stage-specific incidence, characteristics, treatment and relative survival of patients with EO-CRC in the Netherlands and compare these with 50- to 59-year-old patients.
Data from 1989 to 2018 were retrieved from the Netherlands Cancer Registry. Non-standardised age-specific incidence rates were calculated, and trends were assessed using Joinpoint regression. Treatment and 5-year relative survival trends were provided and compared between EO-CRC and 50- to 59-year-old patients.
The EO-CRC incidence annually increased with 0.7–2.1% over the last decades. CRC incidence for the 50- to 59-year-old population annually increased with 0.8–1.7% until 2006 and showed a major increase in incidence after the introduction of nationwide screening in 2014. Stage III and Stage IV CRC primarily increased across the studied age groups, while Stage I and Stage II CRC did not. Patients with EO-CRC received multimodal treatment more often than 50- to 59-year-old patients, but differences were minor. Relative survival increased over time and showed little differences between EO-CRC and 50- to 59-year-old patients.
Only few epidemiological and clinical differences were found between EO-CRC and 50- to 59-year-old patients; hence, the urge for a specific approach of EO-CRC in screening and treatment guidelines might be tempered.
•Early-onset colorectal cancer (EO-CRC) incidence increased in the Netherlands with 0.7–2.1% over the last decades.•This increase in incidence was highly comparable to the 50- to 59-year-old population.•EO-CRC treatment and relative survival differed slightly from 50- to 59-year-old patients with CRC.•The urge for a specific approach of EO-CRC in guidelines might be tempered.
Background
This study assesses the incidence of gastrointestinal symptoms in the first year after resection of esophageal or gastric cancer and its association with health-related quality of life ...(HRQoL), functioning, work productivity, and daily activities.
Patients and Methods
Patients diagnosed with esophageal or gastric cancer between 2015 and 2021, who underwent a resection, and completed ≥ 2 questionnaires from the time intervals prior to resection and 0–3, 3–6, 6–9, and 9–12 months after resection were included. Multivariable generalized linear mixed models were used to assess changes in gastrointestinal symptoms over time and the impact of the number of gastrointestinal symptoms on HRQoL, functioning, work productivity, and daily activities for patients who underwent an esophagectomy or gastrectomy separately.
Results
The study population consisted of 961 (78.8%) and 259 (21.2%) patients who underwent an esophagectomy and gastrectomy, respectively. For both groups, the majority of gastrointestinal symptoms changed significantly over time. Most clinically relevant differences were observed 0–3 after resection compared with prior to resection and included increased diarrhea, appetite loss, and eating restrictions, and specifically after esophagectomy dry mouth, trouble with coughing, and trouble talking. At 9–12 after resection one or more severe gastrointestinal symptoms were reported by 38.9% after esophagectomy and 33.7% after gastrectomy. A higher number of gastrointestinal symptoms was associated with poorer functioning, lower HRQoL, higher impairment in daily activities, and lower work productivity.
Conclusions
This study shows that gastrointestinal symptoms are frequently observed and burdensome after esophagectomy or gastrectomy, highlighting the importance to address these sequelae for high quality survivorship.
Purpose
Differences exist between Asian and Western patients with esophagogastric cancer, for example in terms of histological subtype and treatment strategies. This study aimed to compare ...characteristics and treatment between patients with metastatic esophagogastric cancer from Japan and the Netherlands using nationwide cancer registry data.
Methods
Patients diagnosed with metastatic esophageal or gastric cancer were included from the nationwide national cancer registry of Japan (2016–2019) and the Netherlands (2015–2020). Treatment strategies were analyzed using chi-squared tests.
Results
The proportion of patients with metastatic esophageal (16.0% vs 34.2%) and gastric cancer (14.9% vs 45.2%) were lower in Japan compared to the Netherlands. Japanese patients with metastatic esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC) or gastric cancer (GC) were more often male and older compared to Dutch patients. Proportion of patients with metastatic disease who received surgical resection was higher in Japan compared to the Netherlands (EAC 9.3 vs 1.4%,
p
< 0.001; ESCC 10.7% vs 2.3%,
p
< 0.001; GC 12.0% vs 3.6%
p
< 0.001). Proportion of patients who received systemic therapy was also higher (EAC 44.8% vs 30.4%,
p
< 0.001; ESCC 26.6% vs 12.0%,
p
< 0.001; GC 50.7% vs 35.8%
p
< 0.001).
Conclusions
Japanese patients less often presented with metastatic esophagogastric cancer and more often underwent surgical resection or received systemic therapy compared to Dutch patients. Further investigation should elucidate what the deliberations are in both Japan and the Netherlands and if more patients in the Netherlands could benefit from surgical resection or systemic therapy and whether this would translate in better survival and quality of life.
Purpose
To investigate the effect of systemic therapy on health-related quality of life (HRQoL) in patients with advanced esophagogastric cancer in daily clinical practice. This study assessed the ...HRQoL of patients with esophagogastric cancer during first-line systemic therapy, at disease progression, and after progression in a real-world context.
Methods
Patients with advanced esophagogastric cancer (2014–2021) receiving first-line systemic therapy registered in the Prospective Observational Cohort Study of Oesophageal-gastric cancer (POCOP) were included (
n
= 335). HRQoL was measured with the EORTC QLQ-C30 and QLQ-OG25. Outcomes of mixed-effects models were presented as adjusted mean changes.
Results
Results of the mixed-effect models showed the largest significant improvements during systemic therapy for odynophagia (− 18.9,
p
< 0.001), anxiety (− 18.7,
p
< 0.001), and dysphagia (− 13.8,
p
< 0.001) compared to baseline. After progression, global health status (− 6.3,
p
= 0.002) and cognitive (− 6.2,
p
= 0.001) and social functioning (− 9.7,
p
< 0.001) significantly worsened. At and after progression, physical (− 9.0,
p
< 0.001 and − 8.8,
p
< 0.001) and role functioning (− 15.2,
p
= 0.003 and − 14.7,
p
< 0.001) worsened, respectively. Trouble with taste worsened during systemic therapy (11.5,
p
< 0.001), at progression (12.0,
p
= 0.004), and after progression (15.3,
p
< 0.001).
Conclusion
In general, HRQoL outcomes in patients with advanced esophagogastric cancer improved during first-line therapy. Deterioration in outcomes was mainly observed at and after progression.
Implications for cancer survivors
Identification of HRQoL aspects is important in shared decision-making and to inform patients on the impact of systemic therapy on their HRQoL.
Conditional relative survival (CRS) is useful for communicating prognosis to patients as it provides an estimate of the life expectancy after having survived a certain time after treatment. Our study ...estimates the 3‐year relative survival conditional on having survived a certain period for patients with esophageal or gastric cancer. Patients with nonmetastatic esophageal or gastric cancer diagnosed between 2006 and 2020 treated with curative intent (resection with or without neoadjuvant therapy, or chemoradiotherapy) were selected from the Netherlands Cancer Registry. CRS was calculated since resection or last day of chemoradiotherapy. The probability of surviving an additional 3 years (ie, 3‐year CRS), if the patients survived 1, 3 and 5 years after diagnosis was 62%, 79%, 87% and 69%, 84%, 90% for esophageal and gastric cancer, respectively. The 3‐year CRS after having survived 3 years for patients with esophageal cancer who underwent a resection (n = 12 204) was 91%, 88%, 77% and 60% for pathological Stage 0, I, II and III, and for patients with esophageal cancer who received chemoradiotherapy (n = 4158) was 51% and 66% for clinical Stage II and III, respectively. The 3‐year CRS after having survived 3 years for patients with gastric cancer who underwent a resection (n = 6531) was 99%, 90%, 73% and 59% for pathological Stage 0, I, II and III, respectively. Despite poor prognosis of patients with esophageal or gastric cancer, life expectancy increases substantially after patients have survived several years after treatment. Our study provides valuable information for communication of prognosis to patients during follow‐up after treatment.
What's new?
While 5‐year survival estimates for esophageal or gastric cancer patients are useful at diagnosis, therapeutic outcome and other factors impacting prognosis render them less relevant over time. More accurate estimates may be possible using conditional relative survival (CRS), which is the probability of surviving additional years beyond a fixed time since treatment. Here, the authors calculated CRS for esophageal or gastric cancer patients following treatment with curative intent. Life expectancy was significantly improved for patients who had survived several years beyond primary diagnosis. The findings suggest that once patients have survived past a fixed time posttreatment, CRS estimates are informative.
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