Identificador: TDX:605
Autores: Pascual Torres, Domingo
Resumen:
Introduction. Colorectal cancer (CR) is one of the most frequent neoplasms in developed countries with a survival index lower than 50% in 5 years. In the whole of Spain more than 11.000 cases per year are diagnosed. In Tarragona province it presents a yearly increase of 3.5% in men and of 2.7% in women.. One of the most important aspects in order to improve survival is to set follow-up programs that attempt to detect the most precociously possible relapses and showing up of pre-neoplasic and neoplasic injuries at a curable stage. Hipothesis. From the set out data, we can establish as a work hipothesis that intensive follow-up of CR operated with curative pretense can contribute to improve survival.Objectives. 1.Study of prevalence, incidence and CR tendency analysis in southern Catalonia districts. 2. Analyse and compare monitoring results on survival of those patients who undergone major CR surgery with a radical purpose, as a result of the fullfilment of a strict follow up program (intensive vs. non intensive).3. Relate patient's progress in terms of the state of progress of neoplasm by the moment the diagnosis is done.4. Investigate which are the predictive factors related to CR prognosis, and that, consequently must be included in follow up programes.Material and Methode. In line with the work's hipothesis, objectives and carried out research, patients were distributed into two groups:-Study of prevalence and incidence.-Study of survival.Which have been the object of different analysis according to the objectives.The first group includes those patients diagnosed of CR during the period of the study (1982 - 2001) and that are living in Tarragona province. The analysis is an observative and descriptive type, so that it allows knowledge of the impact of the disease and its incidence, as well as to evaluate possible changes in tendency and progress of the disease. As for the second group a cross section was made, begining 01-01-1989 and going on to 31-12-1996. The section set up a sample of 334 patients. From those, 275 were operated with a radical purpose. It was designed an empiric program of intensive follow up, in which patients were attached to the intensive or non intensive (control) follow up groups according to the strict fulfilment of the program. Values of odds ratio and relative risk have been applied to determine the effectiveness of treatments and follow up systems. Kaplan-Meier survival curves. In order to evaluate the impact of those different variables over the risk of relapses turn up, and over long term survival, logistic regression analysis were fulfilled.Results.Incidence and prevalence. From those 4697 diagnosed CR's, global mortality in that period was of 2591 patients (55.2%). Colorectal cancer shows a fitted tax of 21,9% with males, while in women it is of 17.8%. As for rectum neoplasm, they are of 12,8 and 6,5% respectively. The analysis on the incidence shows us a remarkable annual increase on both sexes, particularly about cancer of the colon, in wich we notice an increase in gross tax of 11% on men and 9% on women. Rectum neoplasm gives us a more moderate increase in relation to male sex (3.1%) whilst to feminine there is some tendency to its decrease (-1.4%). The average age of colon neoplasm diagnosis is placed in 68 for men and 70 for women; As for rectum neoplasm is quite similar (69 and 70 years old respectively). Despite in our province the incidence of survival is lower than in some others, a progressive improvement is noticed. After 5 years survival has increased from 42% to 49% among patients diagnosed between the periods 1985-89.Study of survival. The stage (Dukes) of those 334 patients was: stage A:4.5%; B1: 13.2%; B2: 30.8%; C1: 9.3%; C2: 25.5%; D:14.1%). In 2.7% cases Duke's stage couldn't be determined. From those 275 patients operated with a radical purpose 256 could be followed up, being distributed according to the follow-up method used on them: intensive or non intensive. There were no differences related to homogeneity (P=NS). A lower expression of carcinoembryonic antigen (CEA) was detected in women (P=0.018), differences that were significantly translated in terms of survival. In that group of patients with an increase basal CEA, survival is meaningfuly higher on women (P=0.043) while there were no difference when basal CEA was normal (P=0.132). Settling down of CEA levels after surgery is related to a lower index of suffering a local or loco-regional relapse (RR 3.1) or developing a metastasis (RR 4.2). Survival of those patients with standard CEA in front of those with raised levels is highly significant (P=0.007). Between 23.2% and 70% of patients had a relapse. Relapse at a local anastomotic level and distant metastasis turn up as the most frequent ones. Comparison of relapses in terms of ganglionar damage and/or tumoral penetration degree didn't show a statistic meaning (P=0.319). Twenty-one patients under an intensive follow-up suffered from a local endoscopic relapse and 61.9% of them could be re-operated with a radical purpose, whilst from those patients non-intensively followed-up only 25% (P<0.05) of them were re-operated with differences as to following life. With regard to the relationship between a loco-regional relapse show up as a first relapse on patiens subdued to an intensive follow up in front of those who were not, differences are highly significant (P=0.001). Survival on patients radical-purpose operated and stratified according to the following-up used method, is highly meaningful for those patients object of an intensive follow up (P=0.018). Regression analysis shows us that the most important prognosis factor is the loco-regional relapse (P=0.002). Neoplasm situation (P=0.790) nor post-surgery CEA increasing (P=0.086) are meaningless.Conclusions.1. Survival to CRR at the province increases progressively, from 42% to 49%.2. Sigma neoplasm is the most frequent one (37.7%), followed by rectum neoplasm (34.1%).3. The first symptom of the disease conected to a better result with regard to survival is the change of defecating rate.4. CEA had a statistic value as for survival (P=0.018).5. In the analysed section there is a high index of radical purpose operated patients.6. The most frequent stage was B2 (30.8%), a fact which is connected to a diagnosis in less developed stages.7. Intensive endoscopic follow-up is connected significantly to a higher survival (P<0.001).
Repositori URV