Colorectal cancer survival in Manizales, Colombia, 2008-2017: a population-based study

Guzmán-Gallego, Eduardo Antonio; Arias-Ortiz, Nelson Enrique; Rodríguez-Betancourt, Juan David

doi:10.1590/1980-549720230040

Brasil

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Original Article • Rev. bras. Epidemiol. 26 • 2023 • https://doi.org/10.1590/1980-549720230040 linkcopy

Colorectal cancer survival in Manizales, Colombia, 2008-2017: a population-based study

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ABSTRACT

Objective: To determine 5-year survival in patients with colorectal cancer (CRC) according to patient and tumor characteristics.

Methods: Longitudinal study based on incident cases of invasive CRC between 2008 and 2017 captured by the Manizales Population-based Cancer Registry (n=850). Patients were followed up to August 24^th, 2021. Cause-specific survival and net survival were calculated for sociodemographic and tumor characteristics, and Cox multivariate was fitted.

Results: Fifty-five percent of cases occurred in women. The most frequent histological type was adenocarcinoma (78.2%). The most frequent locations were rectum (32.0%), ascending colon (16.6%), and sigmoid (16.2%). Twenty-five percent of cases were diagnosed in stage IV. There were 567 deaths due to CRC. The 5-year specific survival was 45.8% (95%CI 42.4–49.3), with independent effects for age (HR=1.83; 95%CI 1.26–2.65 age >75 years vs. <50 years) and advanced clinical stage (HR=2.5 and HR 5.7 for stages III and IV vs. stage I, respectively). Lower survival was observed in patients of medium socioeconomic status compared with higher socioeconomic status (HR=1.52; 95%CI 1.08–2.14), but not in patients of low socioeconomic status. No independent effects were observed for the health insurance regime.

Conclusions: In Manizales, approximately 5 out of 10 patients with invasive CRC die in the first five years after diagnosis, with a lower survival in patients older than 75 years, from medium socioeconomic level and diagnosed in advanced clinical stages.

Keywords: Colorectal cancer; Survival; Colombia; Prognosis

		Univariate analysis	Multivariate analysis
		HR (95%CI)	Model A^* * Model A for health insurance: likelihood ratio (LR)=174.12; Schoenfeld test=22.2 p=0.07. Model A for socioeconomic level: LR=163.98; Schoenfeld test=15.1 p=0.37;	Model B^† † Model B: LR=166.02; overall Schoenfeld test=19.5, p=0.27. Schoenfeld residuals=19.5 p=0.27 for model B; Schoenfeld model A assurance=22.2 p=0.07; Model A for socioeconomic level Shoenfeld=15.1 p=0.37). In bold: statistically significant effect measures.
		HR (95%CI)	HR (95%CI)	HR (95%CI)
Insurance
	Private/special/exception	Ref	Ref	Ref
	Contributory	1.55 (0.89–2.70)	1.46 (0.77–2.76)	1.28 (0.68–2.41)
	Subsidized	1.70 (0.95–3.10)	1.89 (0.97–3.68)	1.64 (0.84–3.21)
Socioeconomic level
	High	Ref	Ref	Ref
	Medium	1.36 (1.01–1.85)	1.59 (1.13–2.24)	1.52 (1.08–2.14)
	Low	1.41 (0.96–2.07)	1.52 (0.98–2.34)	1.37 (0.88–2.13)
Gender
	Male	Ref	Ref	Ref
	Female	1.11 (0.93–1.33)	0.95 (0.77–1.18)	0.99 (0.80–1.22)
Age (years)
	<50	Ref	Ref	Ref
	50 to 74	1.13 (0.83–1.52)	1.12 (0.79–1.57)	1.06 (0.74–1.50)
	≥75	1.97 (1.44–2.69)	1.91 (1.32–2.74)	1.83 (1.26–2.65)
Topography
	Colon, SAI	Ref	Ref	Ref
	Rectosigmoid/rectum junction	1.14 (0.94–1.36)	1.14 (0.92–1.41)	1.04 (0.84–1.30)
Histologic subtype
	Adenocarcinomas	Ref	Ref	Ref
	Other histological subtypes and without specification	1.37 (1.13–1.67)	1.13 (0.90–1.25)	1.00 (0.79–1.26)
Clinical stage
	I	Ref	Ref	Ref
	II	1.18 (0.1–1.97)	1.16 (0.69–1.96)	1.23 (0.72–2.12)
	III	2.39 (1.47–3.88)	2.34 (1.42–3.87)	2.51 (1.50–4.21)
	IV	5.24 (3.25–8.43)	5.48 (3.35–8.96)	5.71 (3.44–9.48)

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[TFN1] ^*
Model A for health insurance: likelihood ratio (LR)=174.12; Schoenfeld test=22.2 p=0.07. Model A for socioeconomic level: LR=163.98; Schoenfeld test=15.1 p=0.37;

[TFN2] ^†
Model B: LR=166.02; overall Schoenfeld test=19.5, p=0.27. Schoenfeld residuals=19.5 p=0.27 for model B; Schoenfeld model A assurance=22.2 p=0.07; Model A for socioeconomic level Shoenfeld=15.1 p=0.37). In bold: statistically significant effect measures.