Improved survival of colon cancer due to improved treatment and detection: a nationwide population-based study in The Netherlands 1989-2006.
BACKGROUND
We described changes in treatment of colon cancer over time and the impact on survival in The Netherlands in the period 1989-2006.


METHODS
All 103,744 patients with invasive colon cancer during 1989-2006 in The Netherlands were included. Data were extracted from The Netherlands Cancer Registry. Trends in treatment over time were analysed and multivariable relative survival analysis was carried out.


RESULTS
The administration of adjuvant chemotherapy in stage III patients <75 years increased from 19% in 1989-1993 to 79% in 2004-2006 and from 1% to 19% in stage III patients ≥75 years. Among stage IV patients, resection rates of the primary tumour decreased from 72% to 63%, while chemotherapy administration increased from 23% to 64% in those <75 years. Survival increased from 52% to 58% in males and from 55% to 58% among females. Stage III patients with adjuvant chemotherapy exhibited a relative excess risk of 0.4 (95% confidence interval 0.4-0.4) compared with those without. Among stage IV patients, resection of primary tumour, palliative chemotherapy, and metastasectomy were important prognostic factors.


CONCLUSIONS
There were substantial improvements in management and survival of colon cancer from 1989 to 2006. Stage III disease patients with colon cancer experienced the largest improvement in survival, most likely related to the increased administration of adjuvant chemotherapy.
van Steenbergen
L N
LN
Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven. Electronic address: research@ikz.nl.
Elferink
M A G
MAG
Department of Research, Comprehensive Cancer Centre North East, Enschede/Groningen.
Krijnen
P
P
Comprehensive Cancer Centre West, Leiden.
Lemmens
V E P P
VEPP
Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam.
Siesling
S
S
Department of Research, Comprehensive Cancer Centre North East, Enschede/Groningen; Department of Health Technology and Services Research, Twente University, Enschede.
Rutten
H J T
HJT
Department of Surgery, Catharina Hospital, Eindhoven.
Richel
D J
DJ
Department of Internal Medicine, Academic Medical Centre Amsterdam, The Netherlands.
Karim-Kos
H E
HE
Department of Public Health, Erasmus MC University Medical Centre, Rotterdam.
Coebergh
J W W
JWW
Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam.
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D015996:Survival Rate