title: Baseline mortality-adjusted survival in resected rectal cancer patients.
abstract: BACKGROUND
  This investigation assessed the baseline mortality-adjusted 5-year survival after open rectal cancer resection.
  
  
  METHODS
  The 5-year survival rate was analyzed in 885 consecutive American Joint Committee on Cancer (AJCC) stage I-IV rectal cancer patients undergoing open resection between 2002 and 2011 using risk-adjusted Cox proportional hazards regression models adjusted for population-based baseline mortality.
  
  
  RESULTS
  The 5-year relative and overall survival rates were 80.9%(95% confidence interval (CI): 77.0-85.0%) and 71.9%(95% CI, 68.4-75.5%), respectively. The 5-year relative survival rates for stage I, II, III, and IV cancer were 97.8% (95% CI, 93.1-102.8%), 90.9%(95% CI, 84.3-98.1%), 72.0% (95% CI, 64.7-80.1%), and 24.4% (95% CI: 16.0-37.0%), respectively. After the curative resection of stage I-III rectal cancer, fewer than every other observed death was cancer-related. The 5-year relative survival rate for stage I cancer did not differ from the matched average national baseline mortality rate (P = 0.419). Higher age (hazard ratio (HR) 0.94, 95% CI: 0.92-0.95, P < 0.001) was protective for relative survival but unfavorable for overall survival (HR 1.04, 95% CI: 1.02-1.05, P < 0.001). Female gender was only unfavorable for relative survival (HR 1.59, 95% CI: 1.11-2.29, P = 0.014).
  
  
  CONCLUSIONS
  The analysis of relative survival in a large cohort of rectal cancer patients revealed that stage I rectal cancer is fully curable. The findings regarding age and gender may explain the conflicting results obtained to date from studies based on overall survival.
authors.affiliation: Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Müller
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
authors.forename: Yakup
authors.initials: Y
authors.lastname: Kulu
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D003082:Colectomy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
references.citation: Lancet Oncol. 2008 Aug;9(8):730-56
references.pmid: 18639491
references.citation: Ann Oncol. 2004 Jul;15(7):1013-7
references.pmid: 15205193
references.citation: Stat Med. 2012 Apr 13;31(8):775-86
references.pmid: 22281942
references.citation: Am J Gastroenterol. 2010 Nov;105(11):2457-64
references.pmid: 20700114
references.citation: Br J Surg. 2003 Feb;90(2):205-14
references.pmid: 12555297
references.citation: Am Surg. 2008 Oct;74(10):973-6
references.pmid: 18942625
references.citation: Br J Surg. 1998 Sep;85(9):1255-9
references.pmid: 9752871
references.citation: JAMA. 2004 Jun 9;291(22):2720-6
references.pmid: 15187053
references.citation: Lancet Oncol. 2007 Sep;8(9):773-83
references.pmid: 17714991
references.citation: Biometrics. 1985 Dec;41(4):921-32
references.pmid: 3830258
references.citation: Comput Biol Med. 2007 Dec;37(12):1741-9
references.pmid: 17582396
references.citation: Eur J Cancer. 2008 Jul;44(10):1463-75
references.pmid: 18455387
references.citation: Med Decis Making. 1995 Apr-Jun;15(2):158-69
references.pmid: 7783577
references.citation: Ann Surg Oncol. 2013 Nov;20(12):3877-84
references.pmid: 23907315
references.citation: Int J Cancer. 2008 Jan 15;122(2):398-402
references.pmid: 17724717
references.citation: Clin Cancer Res. 2009 Oct 15;15(20):6391-7
references.pmid: 19789331
references.citation: Semin Oncol. 2009 Oct;36(5):439-50
references.pmid: 19835739
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: Cancer Epidemiol. 2012 Feb;36(1):16-21
references.pmid: 21840284
references.citation: Am J Surg. 2004 Mar;187(3):343-8
references.pmid: 15006562
references.citation: Cancer. 2013 Aug 15;119(16):3084-91
references.pmid: 23720150
references.citation: Int J Colorectal Dis. 2012 Jan;27(1):71-9
references.pmid: 21881876
references.citation: BMC Cancer. 2005 Dec 02;5:153
references.pmid: 16324216
references.citation: ANZ J Surg. 2001 Dec;71(12):707-10
references.pmid: 11906383
references.citation: World J Surg. 2004 Jun;28(6):558-62
references.pmid: 15366745
references.citation: Eur J Cancer. 2008 Jul;44(10):1345-89
references.pmid: 18280139
references.citation: Eur J Cancer. 2007 Mar;43(5):909-13
references.pmid: 17300929
references.citation: Clin Gastroenterol Hepatol. 2009 Jun;7(6):676-81.e1-3
references.pmid: 19514116
references.citation: South Med J. 1981 Aug;74(8):920-4
references.pmid: 7268491
references.citation: Br J Cancer. 2008 Jan 29;98(2):328-34
references.pmid: 18026187