Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993-2010.
BACKGROUND
The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010.


METHODS
A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1).


RESULTS
Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001).


CONCLUSIONS
Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.
a Department of Oncology , Oslo University Hospital , Oslo , Norway.|b K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital , Oslo , Norway.
Marianne G
MG
Guren
c Department of GI Surgery , Stavanger University Hospital , Stavanger , Norway.|d Department of Clinical Medicine , University of Bergen , Bergen , Norway.
Hartwig
H
Kørner
d Department of Clinical Medicine , University of Bergen , Bergen , Norway.|e Department of Surgery , Haukeland University Hospital , Bergen , Norway.
Frank
F
Pfeffer
f Department of Registration , Cancer Registry of Norway , Oslo , Norway.
Tor Å
TÅ
Myklebust
g Department of Digestive Surgery , Akershus University Hospital , Lørenskog , Norway.
Morten T
MT
Eriksen
h Department of Surgery , Levanger Hospital, North-Trondelag Hospital Trust , Levanger , Norway.|i Unit for Applied Clinical Research, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology , Trondheim , Norway.
Tom-Harald
TH
Edna
j Department of Gastroenterological Surgery , Oslo University Hospital , Oslo , Norway.
Stein G
SG
Larsen
f Department of Registration , Cancer Registry of Norway , Oslo , Norway.
Kristin O
KO
Knudsen
b K. G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital , Oslo , Norway.|j Department of Gastroenterological Surgery , Oslo University Hospital , Oslo , Norway.|k Institute of Clinical Medicine, University of Oslo , Oslo , Norway.|l Centre for Cancer Biomedicine, University of Oslo , Oslo , Norway.
Arild
A
Nesbakken
m Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.
Hans H
HH
Wasmuth
n Nordland Hospital Trust , Bodø , Norway.|o University of Tromsø, Institute of Community Medicine , Tromsø , Norway.
Barthold
B
Vonen
p Department of Oncology , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.
Eva
E
Hofsli
g Department of Digestive Surgery , Akershus University Hospital , Lørenskog , Norway.
Arne E
AE
Færden
a Department of Oncology , Oslo University Hospital , Oslo , Norway.
Morten
M
Brændengen
q Department of Clinical Science , MOF, University of Bergen , Bergen , Norway.|r Department of Oncology , Haukeland University Hospital , Bergen , Norway.
Olav
O
Dahl
s Department of Pathology , University Hospital of North Norway , Tromsø , Norway.
Sonja E
SE
Steigen
t Department of Oncology , University Hospital of North Norway , Tromsø , Norway.
Magnar J
MJ
Johansen
u Department of Gastrointestinal Surgery , University Hospital of North Norway , Tromsø , Norway.|v Institute of Clinical Medicine, The Arctic University of Norway , Tromsø , Norway.
Rolv-Ole
RO
Lindsetmo
w Department of Radiology and Nuclear Medicine , Oslo University Hospital , Oslo , Norway.
Anders
A
Drolsum
x Department of Gastroenterology , Nordland Hospital , Bodø , Norway.
Geir
G
Tollåli
f Department of Registration , Cancer Registry of Norway , Oslo , Norway.
Liv M
LM
Dørum
f Department of Registration , Cancer Registry of Norway , Oslo , Norway.
Bjørn
B
Møller
m Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.|y Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology , Trondheim , Norway.
Arne
A
Wibe
D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology*; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D015994:Incidence; D008297:Male; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018365:Neoplasm, Residual; D009664:Norway / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome