Staging and survival of colorectal cancer: are we making progress? The 14-year experience of a Specialized cancer Registry

Background and Aims. It is still unclear whether recent advancements in col orectal cancer research have led to an improvement in management and progno sis of the disease. Through the data of a specialized colorectal cancer Reg istry we aimed at analysing pathological staging and 5-year survival of ail patients with malignancies of large bowel diagnosed between 1984 and 1997. Main objective was to ascertain whether or not we are making progress in t he control of this common neoplasm. Patients and Methods. During the 14-year period 1984-97, a total of 2,240 c olorectal cancer patients were registered, for a crude incidence rate of 64 .5 and 55.2/100,000/year in males and females, respectively Tumours were st aged with "Tumour Node, Metastasis" system, corresponding to Dukes' classif ication, into four main groups. Survival was assessed with Life Table analy sis, and statistical significance - between various subgroups - evaluated w ith Log-Rank Test. Results. Crude incidence rates of colorectal neoplasms showed minor fluctua tions during initial period of registration, increasing sharply after 1990 mainly due to localized (stage I and II) lesions and, to a lesser degree, t o stage ill tumours. Number of advanced (stage IV and unstaged) malignancie s remained virtually stable. When results were expressed as percent of tota l cases, the fraction of localized lesions increased from 39% in the bienni um 1984-5 to 51.6% in 1986-97, and the proportion of advanced tumours fail from 39% to 21.6% (p for trend <0.001). As expected, 5-year survival was si gnificantly (p<0.002) more favourable for individuals diagnosed in 1990-91 than for patients registered in 1984-89. Conclusions. In Northern Italy, incidence rates of colorectal carcinoma are rising. This trend is associated with a sharp increase of newly detected l ocalized lesions and with a significant improvement of overall 5-year survi val The result may be attributed to several concomitant factors, such as: A ) wider use of colonoscopy, B) increased education of patients, C) more att ention given to symptoms.