CRC detected via screening associated with better disease-free, overall survival
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Key takeaways:
- Disease-free survival at 3 years was higher among patients with screen-detected vs. non-screen-detected CRC (87.8% vs. 77.2%)
- Screen detection was independently associated with decreased risk for recurrence.
Disease-free survival at 3 years was significantly higher among patients with screen-detected colorectal cancer vs. those with clinically detected CRC, according to a study conducted in the Netherlands.
“Since the introduction of the Dutch screening program, almost a fifth of all diagnosed CRCs are screen-detected,” Johanna K.F. Pluimers, of the department of gastroenterology and hepatology at Erasmus University Medical Center, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Recent studies have observed discrepancies in treatment choices and treatment outcomes between screen-detected and non-screen-detected CRCs.”
They continued: “Understanding the factors contributing to the overall and stage-specific survival differences between screen-detected and non-screen-detected CRC patients is crucial. This can lead to improved patient counseling and might add to choose the most appropriate treatment strategy.”
In a nationwide, retrospective, population-based cohort study, Pluimers and colleagues used the Netherlands Cancer Registry to identify 3,725 patients aged 55 to 75 years (61.9% aged 61-70 years; 60.4% men) newly diagnosed with stage I to III CRC between January and June 2015. More than half of these patients (55.7%) were symptomatic and had clinically detected CRC (non-screen-detected), while 44.3% were identified via a positive fecal immunochemical test administered through the screening program (screen-detected).
The primary outcome was recurrence among screen-detected vs. non-screening detected patients, as well as the association with overall survival.
According to study results, 16% of all CRCs recurred — 10.8% screen-detected and 20.1% non-screen-detected (P < .001). Disease-free survival at 3 years was significantly higher in screen-detected CRCs (87.8% vs. 77.2%), with stage-specific survival rates of 94.7% vs. 92.3% for stage I, 84.3% vs. 81.4% for stage II and 77.9% vs. 66.7% for stage III.
Multivariable analyses showed screen detection was independently associated with a decreased risk for recurrence (HR = 0.67; 95% CI, 0.55-0.81) across all disease stages and when adjusted for age, gender, tumor location, stage and treatment. In addition, recurrence independently predicted overall survival (HR = 15.9; 95% CI 13.28-19.04) after adjusting for those factors.
“Our study is the first to demonstrate a significantly lower recurrence rate in screen-detected CRC patients compared to non-screen-detected CRC patients after correcting for important confounders,” Pluimers and colleagues wrote. “Given the strong association between disease recurrence and overall survival, this observation may explain the previously reported impact of mode of detection on survival.”
They continued: “Apart from CRC stage, mode of detection could be used to assess an individual’s risk for recurrence and survival, which may contribute to a more personalized treatment.”
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