DOI QR코드

DOI QR Code

Mortality Determinants in Colorectal Cancer Patients at Different Grades: a Prospective, Cohort Study in Iran

  • Ahmadi, Ali (Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences) ;
  • Mosavi-Jarrahi, Alireza (Epidemiology Department, Social Medicine, Medical School, Shahid Beheshti Universitry of Medical Sciences) ;
  • Pourhoseingholi, Mohamad Amin (Research Center for Gastroenterology and Liver diseases, Shahid Beheshti Universitry of Medical Sciences)
  • Published : 2015.03.04

Abstract

Background: Colorectal cancer (CRC) is an important cause of mortality and morbidity in many communities worldwide. This population based study was conducted to assess determinants of colorectal mortality in Iranian patients. Materials and Methods: A cohort of 1,127 cases of confirmed colorectal cancer registered in a population based registry covering 10 referral hospital in Tehran, Iran, were followed for five years. Information about tumor characteristics, smoking status and family history were collected at base line and survival status were followed every six months by contacting patient or next of kin (if patients died during the follow-up). The cause of death for each case was validated by verbal autopsy and referring to patient medical records at the time of death. The data were analyzed by Stata software using univariate and multivariate analysis (Cox regression). In building the model a p value of less than 5% was considered as significant. Results: The age at diagnosis was $53.5{\pm}14$ years. Sixty one percent were male. Colorectal mortality among the patients was 96.9 person-years among men and 83 person-years among women. Seventy five percent of patients lived for 2.72 years, 50% for 5.83, and 25% for 13 years after the diagnosis of colorectal cancer. The age at diagnosis was significantly different between men and women (p<0.03). Higher tumor grade predicted higher death rate; the adjusted hazard ratios were 1.79 (95%CI, 0.88-3.61), 2.16 (95%CI, 1.07-4.37), and 3.1 (95%CI, 1.51-6.34) for grades II, III, and IV respectively when they were compared with grade I as reference. Ethnicity, marital status, family history of cancer, and smoking were related to survival with different degrees of magnitude. Conclusions: Among many factors related to survival among the colorectal patients, tumor grade and smoking showed the highest magnitudes of association.

Keywords

Colorectal cancer;mortality;survival;determinant factors;Iran

References

  1. Jackson-Thompson J, Ahmed F, German RR, Lai SM, Friedman C (2006). Descriptive epidemiology of colorectal cancer in the United States, 1998-2001. Cancer, 107, 1103-11. https://doi.org/10.1002/cncr.22007
  2. Jeffreys M, Stevanovic V, Tobias M, et al (2005). Ethnic inequalities in cancer survival in New Zealand: linkage study. Am J Public Health, 95, 834-7. https://doi.org/10.2105/AJPH.2004.053678
  3. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  4. Johansen C, Schou G, Soll-Johanning H, Mellemgaard A, Lynge E (1998). Marital status and survival in colorectal cancer. Ugeskrift for Laeger, 160, 635-8.
  5. Krieger N, Quesenberry C Jr, Peng T, et al (1999). Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among asian, black, hispanic, and white residents of the San Francisco Bay Area, 1988-92 (United States). Cancer Causes Control, 10, 525-37. https://doi.org/10.1023/A:1008950210967
  6. Merrill RM, Harris JD, Merrill JG (2013). Differences in incidence rates and early detection of cancer among nonhispanic and hispanic whites in the United States. Ethn Dis, 23, 349-55.
  7. Mobasheri M, Ahmadi A (2014). Incidence patterns and spatial analysis of the most common cancers in Southeastern Iran using geographic information system (GIS). Acad J Canc Res, 7, 141-5.
  8. Mohagheghi MA, Mosavi-Jarrahi A, Malekzadeh R, Parkin M (2009). Cancer incidence in Tehran metropolis: the first report from the Tehran Population-based Cancer Registry, 1998-2001. Arch Iran Med, 12, 15-23.
  9. Moradi A, Khayamzadeh M, Guya M, et al (2009). Survival of colorectal cancer in Iran. Asian Pac J Cancer Prev, 10, 583-6.
  10. Pahlavan PS, Kanthan R (2006). The epidemiology and clinical findings of colorectal cancer in Iran. J Gastrointestin Liver Dis, 15, 15-9.
  11. Perencevich M, Ojha RP, Steyerberg EW, Syngal S (2013). Racial and ethnic variations in the effects of family history of colorectal cancer on screening compliance. Gastroenterology, 14, 775-81.
  12. Phipps AI, Baron J, Newcomb PA (2011). Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival: the seattle colon cancer family registry. Cancer, 117, 4948-57. https://doi.org/10.1002/cncr.26114
  13. Ponz de Leon M, Benatti P, Rossi G, et al (2004). Trend of incidence, subsite distribution and staging of colorectal neoplasms in the 15-year experience of a specialised cancer registry. Ann Oncol, 15, 940-60. https://doi.org/10.1093/annonc/mdh224
  14. Safaee A, Fatemi SR, Ashtari S, et al (2012). Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data - implications for screening. Asian Pac J Cancer Prev, 13, 2695-8. https://doi.org/10.7314/APJCP.2012.13.6.2695
  15. Sung JJ, Lau JY, Goh KL, Leung WK (2005). Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol, 6, 871-6. https://doi.org/10.1016/S1470-2045(05)70422-8
  16. van Jaarsveld CH, Miles A, Edwards R, Wardle J (2006). Marriage and cancer prevention: does marital status and inviting both spouses together influence colorectal cancer screening participation? J Med Screen, 13, 172-6.
  17. Doubeni CA, Laiyemo AO, Major JM, et al (2012). Socioeconomic status and the risk of colorectal cancer: an analysis of more than a half million adults in the national institutes of health- AARP diet and health study. Cancer, 118, 3636-44. https://doi.org/10.1002/cncr.26677
  18. Albano JD, Ward E, Jemal A, et al (2007). Cancer mortality in the United States by education level and race. J Natl Cancer Inst, 99, 1384-94. https://doi.org/10.1093/jnci/djm127
  19. Choe JH, Koepsell TD, Heagerty PJ, Taylor VM (2005). Colorectal cancer among asians and pacific islanders in the U.S.: survival disadvantage for the foreign-born. Cancer Detect Prev, 29, 361-8. https://doi.org/10.1016/j.cdp.2005.06.002
  20. Goldzweig G, Andritsch E, Hubert A, et al (2009). How relevant is marital status and gender variables in coping with colorectal cancer? a sample of middle-aged and older cancer survivors. Psychooncology, 18, 866-74. https://doi.org/10.1002/pon.1499
  21. Hill S, Sarfati D, Blakely T, et al (2010). Ethnicity and management of colon cancer in New Zealand: do indigenous patients get a worse deal? Cancer, 116, 3205-14. https://doi.org/10.1002/cncr.25127
  22. Hoffmeister M, Schmitz S, Karmrodt E, et al (2010). Male sex and smoking have a larger impact on the prevalence of colorectal neoplasia than family history of colorectal cancer. Clin Gastroenterol Hepatol, 8, 870-6. https://doi.org/10.1016/j.cgh.2010.07.004
  23. Ward E, Jemal A, Cokkinides V, et al (2004). Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin, 54, 78-93. https://doi.org/10.3322/canjclin.54.2.78
  24. Yuste AL, Aparicio J, Segura A, et al (2003). Analysis of clinical prognostic factors for survival and time to progression in patients with metastatic colorectal cancer treated with 5-fluorouracil-based chemotherapy. Clin Colorectal Cancer, 2, 231-4. https://doi.org/10.3816/CCC.2003.n.004
  25. Zheng XE, Li T, Lipka S, et al (2013). Location-dependent ethnic differences in the risk of colorectal adenoma: a retrospective multiethnic study. J Clin Gastroenterol, 48, 1-7.

Cited by

  1. Application of the Parametric Regression Model with the Four-Parameter Log-Logistic Distribution for Determining of the Effecting Factors on the Survival Rate of Colorectal Cancer Patients in the Presence of Competing Risks vol.19, pp.6, 2017, https://doi.org/10.5812/ircmj.55609