Survival of rectal cancer patients in Belgium 1997-98 and the potential benefit of a national project.
BACKGROUND
PROCARE, a Belgian multidisciplinary project on rectal cancer (RC), will be launched in 2006. Guidelines have been developed, but remain to be implemented.


OBJECTIVE
A population-based study on RC treatment and outcome in Belgium and comparison with recent international benchmarks in order to better define targets that should be reached.


METHODS
Anonymous data of 3079 patients with rectal cancer registered in the National Cancer Registry in 1997 and 1998 were analysed. Observed (OS) and relative survival (RS) were compared with figures from nationwide projects and multi-centre studies.


RESULTS
The 5-yr OS and RS were 46.6% and 58.5%, respectively. For patients with stage I-III tumours 5-yr OS was 57.1% and 5-yr RS 70.1%. Adjuvant or neo-adjuvant treatment was given in 54.8% stage II-III patients who were < 70 years old. There were marked differences between the provinces in the use of radiotherapy for stage II-III patients and in 5-yr RS for all stages. In stage IV, the median OS was 13 months and the 2-yr OS was 28%. Comparison with recent multi-centre trials indicates significant potential benefits from the PROCARE project: an absolute increase of the 5-yr OS by 10 to 20% after chemoradiotherapy and TME in stage II-III patients 75 years old or less, a 7-month increase of the median OS and an absolute 15% increase of the 2-yr OS in unresectable stage IV patients with combined chemotherapy.


CONCLUSIONS
Significant improvement seems to be achievable. Implementation of the PROCARE guidelines with quality assurance through prospective registration in a specific database, however, is a crucial prerequisite for credible audit of performance and feedback to individual teams.
Penninckx
F
F
Department of Abdominal Surgery, UZ Gasthuisberg, Leuven, Belgium. freddy.penninckx@uz.kuleuven.ac.be
Van Eycken
L
L
Michiels
G
G
Mertens
R
R
Bertrand
C
C
De Coninck
D
D
Haustermans
K
K
Jouret
A
A
Kartheuser
A
A
Tinton
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D019985:Benchmarking; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015993:Life Tables; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate