Colonoscopy vs Fecal Immunochemical Testing in Colorectal Cancer Screening
Poster: The impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
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Screening colonoscopy diagnoses yield better colon cancer surgery outcomes R Amri, LG Bordeianou, P Sylla, DL Berger — Department of Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, MA METHODS RESULTS RESULTS INTRODUCTION CONCLUSIONS REFERENCES Screening colonoscopy seemingly decreases the rates of colorectal cancer in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early stage disease, potentially leading to higher survival rates. This study assesses the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence and survival. All patients operated on for colonic adenocarcinoma at our center between 2004 and 2012 were included in the analysis. The population was divided in a group diagnosed through screening colonoscopy and a group diagnosed after presentation with symptoms. After verification for differences in baseline characteristics, we compared the two populations with regards to TNM staging, survival and death rates including relative risk (RR) where applicable. Subsequently, we used a multivariate Cox 1098 patients were operated for colon adenocarcinoma between 2004-2012. 579 (62.6%) were diagnosed after symptomatic presentation, 195 (21.1%) were diagnosed through screening colonoscopy. Baseline characteristics Follow-up and long-term outcomes Symptomatic patients had significantly higher death rates (RR 2.3) and recurrence rates (RR 3.5). Plotting the outcomes on survival and hazard curves after correcting for covariates (fig. 2 and 3 below) demonstrates the significant and lasting gain in disease-free interval (p<0.001) and survival (p<0.001). Patients with colon cancer identified on screening colonoscopy have significantly better staging and outcomes than patients diagnosed through symptoms. Multivariate analysis also revealed that this beneficial effect impacted the long-term survival of colon cancer patients independent of staging. This further emphasizes the utility of screening colonoscopies in prolonging longevity, improving quality of life and reducing healthcare costs through early detection. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011Jun.;61(4):212–36. Table 1. Baseline population characteristics at diagnosis Fig. 1. Distribution of pathology staging Fig. 3. Multivariate Cox proportional hazards curves for survival Fig. 2. Multivariate Cox proportional hazards curves for disease-free interval Patients in the symptomatic group had a significantly higher rate of metastatic disease on presentation (RR= 2.23), were significantly older and had a lower BMI These variables were accounted for in the multivariate model. Differences in staging Table 2. Follow-up and outcome means ACKNOWLEDGEMENTS This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.) This work was also supported by the Fulbright Foundation. Symptomatic patients had significantly higher T stages and were at higher risk of having nodal (RR 1.98) and metastatic (RR 5.22) disease (all p<0.001).
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Transcript of Poster: The impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
Screening colonoscopy diagnoses yield better colon cancer surgery outcomesR Amri, LG Bordeianou, P Sylla, DL Berger — Department of Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, MA
METHODSMETHODS
RESULTSRESULTS RESULTSRESULTSINTRODUCTIONINTRODUCTION CONCLUSIONSCONCLUSIONS
REFERENCESREFERENCES
Screening colonoscopy seemingly decreases the rates of colorectal cancer in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early stage disease, potentially leading to higher survival rates. This study assesses the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence and survival.
All patients operated on for colonic adenocarcinoma at our center between 2004 and 2012 were included in the analysis. The population was divided in a group diagnosed through screening colonoscopy and a group diagnosed after presentation with symptoms.
After verification for differences in baseline characteristics, we compared the two populations with regards to TNM staging, survival and death rates including relative risk (RR) where applicable.
Subsequently, we used a multivariate Cox proportional hazards regression model to verify if survival and death rates differed independently of staging.
1098 patients were operated for colon adenocarcinoma between 2004-2012. 579 (62.6%) were diagnosed after symptomatic presentation, 195 (21.1%) were diagnosed through screening colonoscopy.
Baseline characteristics
Follow-up and long-term outcomes
Symptomatic patients had significantly higher death rates (RR 2.3) and recurrence rates (RR 3.5).
Plotting the outcomes on survival and hazard curves after correcting for covariates (fig. 2 and 3 below) demonstrates the significant and lasting gain in disease-free interval (p<0.001) and survival (p<0.001).
Patients with colon cancer identified on screening colonoscopy have significantly better staging and outcomes than patients diagnosed through symptoms.
Multivariate analysis also revealed that this beneficial effect impacted the long-term survival of colon cancer patients independent of staging.
This further emphasizes the utility of screening colonoscopies in prolonging longevity, improving quality of life and reducing healthcare costs through early detection.
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011Jun.;61(4):212–36.
Table 1. Baseline population characteristics at diagnosis
Fig. 1. Distribution of pathology staging
Fig. 3. Multivariate Cox proportional hazards curves for survival
Fig. 2. Multivariate Cox proportional hazards curves for disease-free interval
Patients in the symptomatic group had a significantly higher rate of metastatic disease on presentation (RR= 2.23), were significantly older and had a lower BMI These variables were accounted for in the multivariate model.
Differences in staging
Table 2. Follow-up and outcome means
ACKNOWLEDGEMENTSACKNOWLEDGEMENTSThis work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health.)This work was also supported by the Fulbright Foundation.
Symptomatic patients had significantly higher T stages and were at higher risk of having nodal (RR 1.98) and metastatic (RR 5.22) disease (all p<0.001).
