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CC BY 4.0 · Endoscopy 2024; 56(01): 5-13
DOI: 10.1055/a-2173-5989
Original article

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Esther Toes-Zoutendijk  ‡   ‡
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Emilie C. H. Breekveldt‡   ‡
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
2   Department of Gastrointestinal Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
,
Lisa van der Schee
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Iris D. Nagtegaal
4   Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Marloes A. G. Elferink
5   Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
,
Iris Lansdorp-Vogelaar
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Leon M. G. Moons
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Monique E. van Leerdam
2   Department of Gastrointestinal Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
6   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Correction: Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening programEndoscopy eFirst
DOI: 10.1055/a-2217-6054

Abstract

Background Screen-detected colorectal cancers (CRCs) are often treated less invasively than stage-matched non-screen-detected CRCs, but the reasons for this are not fully understood. This study evaluated the treatment of stage I CRCs detected within and outside of the screening program in the Netherlands.

Methods Data from the Netherlands Cancer Registry for all stage I CRCs diagnosed between January 1, 2008 and December 31, 2020 were analyzed, comparing patient, tumor, and treatment characteristics of screen-detected and non-screen-detected stage I CRCs. Multivariable logistic regression was used to assess the association between treatment (local excision only vs. surgical oncologic resection) and patient and tumor characteristics, stratified for T stage and tumor location.

Results Screen-detected stage I CRCs were relatively more often T1 than T2 compared with non-screen-detected stage I CRCs (66.9 % vs. 53.3 %; P < 0.001). When only T1 tumors were considered, both screen-detected colon and rectal cancers were more often treated with local excision only than non-screen-detected T1 cancers (odds ratio [OR] 2.19, 95 %CI 1.93–2.49; and OR 1.29, 95 %CI 1.05–1.59, respectively), adjusted for sex, tumor location, lymphovascular invasion (LVI) status, and tumor differentiation.

Conclusions Less invasive treatment of screen-detected stage I CRC is partly explained by the higher rate of T1 cancers compared with non-screen-detected stage I CRCs. T1 stage I screen-detected CRCs were also more likely to undergo less invasive treatment than non-screen-detected CRCs, adjusted for risk factors such as LVI and tumor differentiation. Future research should investigate whether the choice of local excision was related to unidentified cancer-related factors or the expertise of the endoscopists.

‡ Joint first authors


Table 1 s



Publication History

Received: 10 March 2023

Accepted: 17 August 2023

Article published online:
07 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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  • References

  • 1 Schreuders EH, Ruco A, Rabeneck L. et al. Colorectal cancer screening: A global overview of existing programmes. Gut 2015; 64: 1637-1649
    CrossrefPubMedGoogle Scholar
  • 2 Cardoso R, Guo F, Heisser T. et al. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol 2021; 22: 1002-1013
    CrossrefPubMedGoogle Scholar
  • 3 Breekveldt ECH, Toes-Zoutendijk E, Spaander MCW. et al. Advanced-stage CRC incidence patterns following the phased implementation of the CRC screening programme in the Netherlands. Eur J Cancer 2022; 178: 60-67
    CrossrefPubMedGoogle Scholar
  • 4 Toes-Zoutendijk E, Kooyker AI, Elferink MA. et al. Stage distribution of screen-detected colorectal cancers in the Netherlands. Gut 2018; 67: 1745-1746
    CrossrefPubMedGoogle Scholar
  • 5 Larsen MB, Njor S, Ingeholm P. et al. Effectiveness of colorectal cancer screening in detecting earlier-stage disease-A nationwide cohort study in Denmark. Gastroenterology 2018; 155: 99-106
    CrossrefPubMedGoogle Scholar
  • 6 Breekveldt ECH, Lansdorp-Vogelaar I, Toes-Zoutendijk E. et al. Colorectal cancer incidence, mortality, tumour characteristics, and treatment before and after introduction of the faecal immunochemical testing-based screening programme in the Netherlands: a population-based study. Lancet Gastroenterol Hepatol 2022; 7: 60-68
    CrossrefPubMedGoogle Scholar
  • 7 Krul MF, Elferink MAG, Kok NFM. et al. Initial impact of national CRC screening on incidence and advanced colorectal cancer. Clin Gastroenterol Hepatol 2023; 21: 797-807
    CrossrefPubMedGoogle Scholar
  • 8 Federatie Medische Specialisten. Richtlijnen Database. Accessed: 31 August 2023 https://richtlijnendatabase.nl/richtlijn/colorectaal_carcinoom_crc/primaire_behandeling_coloncarcinoom_bij_crc.html
    PubMedGoogle Scholar
  • 9 Chiu HM, Jen GH, Wang YW. et al. Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers. Gut 2021; 70: 2321-2329
    CrossrefPubMedGoogle Scholar
  • 10 Randel KR, Schult AL, Botteri E. et al. Colorectal cancer screening with repeated fecal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial. Gastroenterology 2021; 160: 1085-1096.e5
    CrossrefPubMedGoogle Scholar
  • 11 Senore C, Giovo I, Ribaldone DG. et al. Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators. Eur J Surg Oncol 2018; 44: 1873-1879
    CrossrefPubMedGoogle Scholar
  • 12 Cappellesso R, Luchini C, Veronese N. et al. Tumor budding as a risk factor for nodal metastasis in pT1 colorectal cancers: a meta-analysis. Hum Pathol 2017; 65: 62-70
    CrossrefPubMedGoogle Scholar
  • 13 Beaton C, Twine CP, Williams GL. et al. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 2013; 15: 788-797
    CrossrefPubMedGoogle Scholar
  • 14 Bosch SL, Teerenstra S, de Wilt JH. et al. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions. Endoscopy 2013; 45: 827-834
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Dykstra MA, Gimon TI, Ronksley PE. et al. Classic and novel histopathologic risk factors for lymph node metastasis in T1 colorectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2021; 64: 1139-1150
    CrossrefPubMedGoogle Scholar
  • 16 Toes-Zoutendijk E, van Leerdam ME, Dekker E. et al. Real-time monitoring of results during first year of Dutch Colorectal Cancer Screening Program and optimization by altering fecal immunochemical test cut-off levels. Gastroenterology 2017; 152: 767-775
    CrossrefPubMedGoogle Scholar
  • 17 TNM classification of malignant tumours. Brierley JD, Gospodarowicz MK, Wittekind C. Oxford: Wiley Blackwell; 2016
    Google Scholar
  • 18 TNM classification of malignant tumours. Wittekind C, Asamura H, Sobin LH. Oxford: Wiley; 2002
    Google Scholar
  • 19 TNM classification of malignant tumours. Wittekind C, Asamura H, Sobin LH. Oxford: Wiley Blackwell; 2010
    Google Scholar
  • 20 Gill MD, Rutter MD, Holtham SJ. Management and short-term outcome of malignant colorectal polyps in the north of England. Colorectal Dis 2013; 15: 169-176
    CrossrefPubMedGoogle Scholar
  • 21 Cooper JA, Parsons N, Stinton C. et al. Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model. Br J Cancer 2018; 118: 285-293
    CrossrefPubMedGoogle Scholar
  • 22 Grainville T, Bretagne JF, Piette C. et al. Management of T1 colorectal cancers detected at screening colonoscopy: A study from the French national screening programme. Dig Liver Dis 2020; 52: 909-917
    CrossrefPubMedGoogle Scholar
  • 23 Shinji S, Yamada T, Matsuda A. et al. Recent advances in the treatment of colorectal cancer: a review. J Nippon Med Sch 2022; 89: 246-254
    CrossrefPubMedGoogle Scholar
  • 24 Bronzwaer MES, Depla ACTM, van Lelyveld N. et al. Quality assurance of colonoscopy within the Dutch national colorectal cancer screening program. Gastrointest Endosc 2019; 89: 1-13
    CrossrefPubMedGoogle Scholar
  • 25 Zammit AP, Lyons NJ, Chatfield MD. et al. Patient and pathological predictors of management strategy for malignant polyps following polypectomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022  37: 1035-1047
    CrossrefPubMedGoogle Scholar
  • 26 Zwager LW, Bastiaansen BAJ, Montazeri NSM. et al. Deep submucosal invasion is not an independent risk factor for lymph node metastasis in T1 colorectal cancer: a meta-analysis. Gastroenterology 2022; 163: 174-189
    CrossrefPubMedGoogle Scholar
  • 27 Richards CH, Ventham NT, Mansouri D. et al. An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). Gut 2018; 67: 299-306
    CrossrefPubMedGoogle Scholar
  • 28 Oh EH, Kim N, Hwang SW. et al. Comparison of long-term recurrence-free survival between primary surgery and endoscopic resection followed by secondary surgery in T1 colorectal cancer. Gastrointest Endosc 2021; 94: 394-404
    CrossrefPubMedGoogle Scholar