Embed Size (px)
Citation preview
Women Are Diagnosed With Colon Cancer Less Often Through Screening,
Worsening Staging and Prognosis
Ramzi Amri,1,2 Liliana G Bordeianou,1,2 Patricia Sylla,1,2 David L Berger 1,2
1 Massachusetts General Hospital, Division of General and Gastrointestinal Surgery.2 Harvard Medical School, Department of Surgery.
02/05/159th Annual Academic Surgical Congress, February 4-6 2014
Integrated Oral Presentations I: Clinical Trials/Outcomes 2: Colorectal (22.9)
Introduction
• Colon cancer affects men, women equally
• Screening is independent of gender
• Women historically fare slightly better 1
• Screening changes the affected population
• Reports show underscreening in women2-5
➤Is this true for our center?
➤What are the implications?1 Murphy G, et al. Int J Cancer. 2011;128(7):1668–1675. 2 Meissner HI, et al. . Cancer Epidemiol Biomarkers Prev. 2006;15(2):389–394.3 Shapiro JA, et al. Cancer Epidemiol Biomarkers Prev. 2012;21(6):895–904. 4 Stock C, et al. Gastrointest Endosc. 2010;71(2):366–381.e2. 5 Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2008;57(10):253–258.
Methods
• Included: • Surgical colon cancer patients at MGH 2004-2011
• >50, no prior CRC: n=919
• Comparison:• Men vs. women• Non-screened women vs. other patients
• Statistical analysis• Ordinal: χ2, continuous: Mann Whitney U• Multivariate: Cox & binary logistic regression
Results: baseline
Women presented with:
•Higher median age•Lower CRC-associated comorbidity•Better lifestyle
But
•Lower screening rates
Male Female P-value
N (%) 468 (50.9%) 451 (49.1%) - Age (median, IQR) 68 (17) 71 (20) 0.012 Comorbidities Charlson (mean, ±SD) 3.16 (1.6) 3.26 (1.9) 0.56 DM2 22.2% 17.1% 0.05 IBD 3.8% 1.8% 0.058 Lifestyle Current smoking 14.3% 10.2% 0.057 Ever smoking 65.0% 46.4% <0.001 BMI (mean, ±SD) 28.2 (5.8) 27.0 (6.8) 0.004 Presentation Symptomatic 59.2% 64.5% 0.096 Emergency admission 9.4% 10.6% 0.53 Screening diagnosis 32.7% 26.4% 0.036
Endoscopy – Low risk 25.0% 19.7% 0.056 Endoscopy – Hx polyps 5.8% 4.7% 0.47 FOBT* 3.6% 3.3% 0.92
Palliative cases 1.7% 1.8% 0.94 Preop. chemotherapy 3.4% 1.8% 0.12 History of polyps 13.5% 13.1% 0.87
Results
Non-screening Women (n=332)
Others
(n=587)
RR (95% CI) P-value
Surgery Surgery duration (M, mn) 118 (108) 127 (95) - 0.053 Multivisceral resection (%) 20.2% 9.0% 2.26 (1.62-3.17) <0.001
Pathology Nodal metastasis (%N+) 47.6% 34.8% 1.36 (1.16-1.59) <0.001 Distant metastasis (%M1) 12.3% 5.5% 2.27 (1.45-3.53) <0.001 High-grade tumor (%) 26.1% 16.1% 1.62 (1.23-2.13) <0.001 EMVI (%) 34.5% 25.9% 1.34 (1.09-1.63) 0.005
Admission Duration of stay (M, days) 5 (4) 4 (4) - 0.035 Perioperative metastasis 17.8% 11.1% 1.60 (1.15-2.22) 0.004 Mortality (%) 2.4% 1.0% 2.35 (0.83-6.74) 0.11
Results
Univariate Multivariate
Binary outcomes (logistic regression)
OR (95% CI) P-value Covariates OR (95% CI) P-value
Metastatic disease 1.59 (1.17-2.17) 0.003 FU 1.52 (1.12-2.08) 0.008
FU, AJCC 0.95 (0.65-1.39) 0.80
Metastasis in follow-up 1.27 (0.84-1.94) 0.26 FU 1.28 (0.84-1.95) 0.25
FU, AJCC 1.05 (0.68-1.62) 0.83
Death – all causes 1.84 (1.39-2.44) <0.001 Age, CC 1.43 (1.04-1.96) 0.027
Age, CC, AJCC 1.14 (0.82-1.59) 0.43
Death – colon cancer 1.95 (1.38-2.75) <0.001 Age, CC 1.73 (1.19-2.51) 0.004
Age, CC, AJCC 1.30 (0.87-1.96) 0.20 Duration outcomes
(Cox regression) HR (95% CI) P-value Covariates HR (95% CI) P-value
Survival duration 1.66 (1.32-2.08) <0.001 Age, CC 1.44 (0.96-1.53) 0.002
Age, CC, AJCC 1.02 (0.80-1.28) 0.90
Disease-free survival 1.52 (1.17-1.98) 0.002 Met. Presentation 1.10 (0.84-1.44) 0.48
AJCC 1.00 (0.77-1.31) 0.98
FU: Follow-up; CC: Colon cancer-adjusted Charlson comorbidity score; AJCC: Staging OR: odds ratio HR: hazard ratio –calculated for non-screening women vs. other patients
Conclusions
• Women were less likely to be diagnosed through screening means.
• Unscreened women: 73% added risk of mortality• Multivariate models: link with staging• Screening∨Advanced disease∧Mortality∧• Disparities in screening = disparities in
outcomes• Limitation: single-center.• Further research: Why
