title: "What if I do nothing?" The natural history of operable cancer of the alimentary tract.
abstract: BACKGROUND
  "Natural history", or anticipated survival without treatment, is critical for patients weighing risks and benefits of cancer surgery. Current estimates concerning the natural history of cancer includes patients whose poor health precludes treatment; a cohort whose fate is likely distinctly worse than those eligible for surgery ("operable"). The study objective was to evaluate survival among patients recommended for cancer surgery but went untreated, to determine the natural history of "operable" alimentary tract cancer.
  
  
  METHODS
  The NCDB was queried for untreated patients with clinical stage I-III esophageal, gastric, colon, and rectal cancer diagnosed between 2003 and 2009. Untreated patients who were recommended for surgery were considered "operable," while patients coded as surgically ineligible for health reasons were "inoperable."
  
  
  RESULTS
  5-year survival of untreated, "operable" alimentary tract cancers varied by clinical stage: esophageal cI = 10.0%, cII = 9.8%, cIII = 4.6%; gastric cI = 9.2%, cII = 5.8%, cIII = 4.3%; colon cI = 18.4%, cII = 5.0%, cIII = 10.4; and rectal cI = 17.1%, cII = 14.0%, cIII = 19.9%. At every timepoint, stage-specific survival of "operable" patients was superior to inoperable patients (p < 0.05). Additionally, median survival among "operable" patients at least doubled "inoperable" patients for each tumor.
  
  
  CONCLUSIONS
  Natural history of patients with "operable" alimentary tract cancer is superior to that of "inoperable" patients. Preoperative counseling should be refined to reflect this distinction.
authors.affiliation: Yale School of Medicine, Department of Thoracic Surgery, USA; Cleveland Clinic Foundation, Department General Surgery, USA.
authors.forename: H B
authors.initials: HB
authors.lastname: Keshava
authors.affiliation: Yale School of Medicine, Department of Thoracic Surgery, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Rosen
authors.affiliation: Yale School of Medicine, Department of General Surgery, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: DeLuzio
authors.affiliation: Yale School of Medicine, Department of Thoracic Surgery, USA.
authors.forename: A W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Yale School of Medicine, Department of Thoracic Surgery, USA.
authors.forename: F C
authors.initials: FC
authors.lastname: Detterbeck
authors.affiliation: Yale School of Medicine, Department of Thoracic Surgery, USA. Electronic address: Daniel.boffa@yale.edu.
authors.forename: D J
authors.initials: DJ
authors.lastname: Boffa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality*; D002294:Carcinoma, Squamous Cell / Q000401:mortality*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology; D016208:Databases, Factual; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology; D015996:Survival Rate; D014481:United States; D057832:Watchful Waiting
keywords: Cancer survival; National Cancer Database; Natural history