THE NATIONAL CANCER DATA-BASE REPORT ON PATTERNS OF CARE FOR ADENOCARCINOMA OF THE RECTUM, 1985-1995

BACKGROUND. The Commission on Cancer data from the National Cancer Dat a Base (NCDB) examining current time trends (1985-1995) in stage of di sease, treatment patterns, and survival relating to patients with rect al adenocarcinoma are described in this report. METHODS. Seven calls f or data to hospital cancer registries across the U. S. have yielded a total of 5,850,000 cancer cases for the years 1985-1995 and include 20 ,461 rectal and rectosigmoid junction adenocarcinoma cases in 1985-198 6, 36,007 cases in 1989-1990, and 42,069 cases in 1994-1995. These dat a represent 24.4%, 44.5%, and 52.5%, respectively, of the estimated ca ses of rectal and rectosigmoid adenocarcinoma cases diagnosed in the U . S. in each of the 3 respective time periods. Analysis of the data is limited to cases with American Joint Committee on Cancer (AJCC) Stage I-IV disease. RESULTS. Four trends were observed. 1) Stage I disease was diagnosed with decreasing frequency, decreasing from 37.1% of case s with known AJCC stage of disease in 1985-1986 to 33.8% in 1994-1995. 2) There was an increase in the frequency with which local excision w as utilized as all or part of the primary treatment for Stage I diseas e. 3) Stage for stage, there was an increase in the frequency with whi ch anterior/posterior resections were utilized and a corresponding dec line in the use of abdominoperineal resections. 4) Multimodal treatmen t regimens are being used with greater frequency, particularly in pati ents with Stage II and III disease. CONCLUSIONS. The NCDB data have im portant implications for analyzing cancer treatment and outcome in the U, S. These data suggest that rectal adenocarcinoma is being diagnose d at a later stage, especially among the young and African Americans. The guidelines for colorectal carcinoma screening issued by the Americ an Cancer Society and the American Gastroenterological Association sho uld be promoted more vigorously to increase the proportion of patients presenting with early stage disease and improve overall survival. The increased use of multimodal therapy for the treatment of Stage II and III disease continues. (C) 1998 American Cancer Society.