Background
Methods
Cohort definition: surveillance, epidemiology, and end results
Statistical analysis
Results
Patient characteristics
Patient characteristics | |||||
---|---|---|---|---|---|
Total | Right-sided carcinoma | Left-sided carcinoma | Pa
| ||
N = 91,416 |
N = 51,937 |
N = 39,479 | |||
Tumor stage | Stage I | 25,482 (27.9 %) | 13,864 (26.7 %) | 11,618 (29.4 %) | <0.001 |
(AJCC 6th ed.) | Stage II | 33,323 (36.5 %) | 19,965 (38.4 %) | 13,358 (33.8 %) | |
Stage III | 32,611 (35.7 %) | 18,108 (34.9 %) | 14,503 (36.7 %) | ||
T-stage | T1 | 14,110 (15.4 %) | 6415 (12.4 %) | 7695 (19.5 %) | <0.001 |
T2 | 15,873 (17.4 %) | 9580 (18.4 %) | 6293 (15.9 %) | ||
T3 | 51,416 (56.2 %) | 29,980 (57.7 %) | 21,436 (54.3 %) | ||
T4 | 10,017 (11.0 %) | 5962 (11.5 %) | 4055 (10.3 %) | ||
Number of positive | 0 | 58,805 (64.3 %) | 33,829 (65.1 %) | 24,976 (63.3 %) | <0.001 |
regional lymph nodes | 1 | 10,557 (11.5 %) | 5627 (10.8 %) | 4930 (12.5 %) | |
2–3 | 10,531 (11.5 %) | 5672 (10.9 %) | 4859 (12.3 %) | ||
4–6 | 6560 (7.2 %) | 3692 (7.1 %) | 2868 (7.3 %) | ||
7+ | 4963 (5.4 %) | 3117 (6.0 %) | 1846 (4.7 %) | ||
Number of retrieved | <12 lymph nodes | 24,256 (26.5 %) | 10,243 (19.7 %) | 14,013 (35.5 %) | <0.001 |
regional lymph nodes | 12–16 lymph nodes | 26,123 (28.6 %) | 14,917 (28.7 %) | 11,206 (28.4 %) | |
17+ lymph nodes | 41,037 (44.9 %) | 26,777 (51.6 %) | 14,260 (36.1 %) | ||
Grading | G1 | 8568 (9.4 %) | 4721 (9.1 %) | 3847 (9.7 %) | <0.001 |
G2 | 64,221 (70.3 %) | 34,812 (67.0 %) | 29,409 (74.5 %) | ||
G3 | 14,228 (15.6 %) | 9886 (19.0 %) | 4342 (11.0 %) | ||
G4 | 1490 (1.6 %) | 1099 (2.1 %) | 391 (1.0 %) | ||
Unknown | 2909 (3.2 %) | 1419 (2.7 %) | 1490 (3.8 %) | ||
Histology | Adenocarcinoma | 64,760 (70.8 %) | 35,637 (68.6 %) | 29,123 (73.8 %) | <0.001 |
Adeno-Ca in adenomatous polyp | 6791 (7.4 %) | 2885 (5.6 %) | 3906 (9.9 %) | ||
Adeno-Ca in villous adenoma | 2646 (2.9 %) | 1721 (3.3 %) | 925 (2.3 %) | ||
Adeno-Ca in tubulovillous adenoma | 8142 (8.9 %) | 4897 (9.4 %) | 3245 (8.2 %) | ||
Mucinous carcinoma | 9077 (9.9 %) | 6797 (13.1 %) | 2280 (5.8 %) | ||
CEA | C0-stage | 32,999 (36.1 %) | 18,679 (36.0 %) | 14,320 (36.3 %) | 0.185 |
C1-stage | 17,232 (18.9 %) | 9896 (19.1 %) | 7336 (18.6 %) | ||
Unknown/Borderline | 41,185 (45.1 %) | 23,362 (45.0 %) | 17,823 (45.1 %) | ||
Operation | Segmental resection | 36,201 (39.6 %) | 7750 (14.9 %) | 28,451 (72.1 %) | <0.001 |
Hemi/subtotal colectomy | 54,241 (59.3 %) | 43,777 (84.3 %) | 10,464 (26.5 %) | ||
Other | 974 (1.1 %) | 410 (0.8 %) | 564 (1.4 %) | ||
Year | 2004 to 2006 | 31,514 (34.5 %) | 17,703 (34.1 %) | 13,811 (35.0 %) | 0.005 |
2007 to 2009 | 31,314 (34.3 %) | 17,798 (34.3 %) | 13,516 (34.2 %) | ||
2010 to 2012 | 28,588 (31.3 %) | 16,436 (31.6 %) | 12,152 (30.8 %) | ||
Age | Up to 49 years | 8015 (8.8 %) | 3175 (6.1 %) | 4840 (12.3 %) | <0.001 |
50 to 64 years | 26,347 (28.8 %) | 12,344 (23.8 %) | 14,003 (35.5 %) | ||
65 to 79 years | 35,693 (39.0 %) | 21,435 (41.3 %) | 14,258 (36.1 %) | ||
80+ years | 21,361 (23.4 %) | 14,983 (28.8 %) | 6378 (16.2 %) | ||
Gender | Male | 43,981 (48.1 %) | 23,053 (44.4 %) | 20,928 (53.0 %) | <0.001 |
Female | 47,435 (51.9 %) | 28,884 (55.6 %) | 18,551 (47.0 %) | ||
Ethnicity | Caucasian | 72,937 (79.8 %) | 42,296 (81.4 %) | 30,641 (77.6 %) | <0.001 |
African-American | 10,572 (11.6 %) | 6286 (12.1 %) | 4286 (10.9 %) | ||
Other/Unknown | 7907 (8.6 %) | 3355 (6.5 %) | 4552 (11.5 %) | ||
Marital status | Married | 49,901 (54.6 %) | 27,219 (52.4 %) | 22,682 (57.5 %) | <0.001 |
Single | 11,581 (12.7 %) | 6120 (11.8 %) | 5461 (13.8 %) | ||
Widowed | 17,770 (19.4 %) | 11,835 (22.8 %) | 5935 (15.0 %) | ||
Other/Unknown | 12,164 (13.3 %) | 6763 (13.0 %) | 5401 (13.7 %) |
Impact of cancer location on survival
Cox regression for overall survival | Cox regression for cancer-specific survival | ||||||||
---|---|---|---|---|---|---|---|---|---|
Unadjusteda
| Adjustedb
| Unadjusteda
| Adjustedb
| ||||||
HR (95 % CI) |
p
c
| HR (95 % CI) |
p
c
| HR (95 % CI) |
p
c
| HR (95 % CI) |
p
c
| ||
Cancer side | Left-sided | Reference | <0.001 | Reference | 0.002 | Reference | <0.001 | Reference | 0.156 |
Right-sided | 1.32 (1.29–1.36) | 1.05 (1.02–1.09) | 1.23 (1.19–1.27) | 1.03 (0.99–1.08) | |||||
Tumor stage | Stage I | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
(AJCC 6th ed.) | Stage II | 1.65 (1.59–1.71) | 1.40 (1.35–1.45) | 3.00 (2.81–3.20) | 2.47 (2.31–2.65) | ||||
Stage III | 2.34 (2.26–2.42) | 2.30 (2.22–2.39) | 6.41 (6.02–6.81) | 5.79 (5.42–6.18) | |||||
Number of retrieved | <12 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
Regional lymph | 12–16 | 0.90 (0.87–0.92) | 0.82 (0.79–0.84) | 0.92 (0.88–0.96) | 0.78 (0.75–0.82) | ||||
Nodes | 17+ | 0.75 (0.73–0.77) | 0.69 (0.67–0.72) | 0.81 (0.78–0.84) | 0.66 (0.64–0.69) | ||||
Grading | G1 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
G2 | 1.20 (1.14–1.26) | 1.05 (1.00–1.10) | 1.46 (1.36–1.56) | 1.10 (1.03–1.18) | |||||
G3 | 1.76 (1.67–1.85) | 1.28 (1.21–1.35) | 2.60 (2.41–2.81) | 1.51 (1.40–1.64) | |||||
G4 | 2.02 (1.83–2.22) | 1.50 (1.36–1.66) | 2.88 (2.53–3.27) | 1.69 (1.49–1.93) | |||||
Unknown | 0.91 (0.84–1.00) | 1.04 (0.95–1.14) | 1.03 (0.91–1.18) | 1.20 (1.06–1.37) | |||||
Histology | Adenocarcinoma | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
Adenocarcinoma in adenomatous polyp | 0.53 (0.50–0.56) | 0.80 (0.76–0.86) | 0.36 (0.33–0.40) | 0.71 (0.64–0.79) | |||||
Adenocarcinoma in villous adenoma | 0.77 (0.71–0.83) | 0.93 (0.86–1.01) | 0.62 (0.55–0.70) | 0.92 (0.82–1.03) | |||||
Adenocarcinoma in tubulovillous adenoma | 0.63 (0.60–0.67) | 0.84 (0.80–0.89) | 0.44 (0.40–0.47) | 0.73 (0.67–0.79) | |||||
Mucinous carcinoma | 1.12 (1.08–1.17) | 1.03 (0.99–1.07) | 1.14 (1.08–1.20) | 1.05 (0.99–1.10) | |||||
CEA | C0-stage | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
C1-stage | 1.91 (1.84–1.97) | 1.61 (1.56–1.67) | 2.29 (2.19–2.40) | 1.79 (1.71–1.87) | |||||
Unknown/Borderline | 1.42 (1.38–1.46) | 1.37 (1.33–1.41) | 1.49 (1.43–1.55) | 1.48 (1.42–1.54) | |||||
Operation | Segmental resection | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
Hemi/subtotal colectomy | 1.27 (1.24–1.30) | 1.08 (1.05–1.12) | 1.26 (1.22–1.31) | 1.11 (1.06–1.16) | |||||
Other | 1.32 (1.18–1.48) | 1.34 (1.19–1.50) | 1.66 (1.44–1.91) | 1.57 (1.36–1.81) | |||||
Year | 2004 to 2006 | Reference | <0.001 | Reference | 0.258 | Reference | <0.001 | Reference | 0.542 |
2007 to 2009 | 0.93 (0.91–0.96) | 1.02 (0.99–1.05) | 0.93 (0.89–0.96) | 1.02 (0.98–1.06) | |||||
2010 to 2012 | 0.87 (0.83–0.90) | 0.98 (0.94–1.03) | 0.87 (0.83–0.92) | 0.99 (0.94–1.05) | |||||
Age | Up to 49 years | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
50 to 64 years | 1.14 (1.07–1.22) | 1.20 (1.12–1.28) | 0.94 (0.87–1.01) | 1.04 (0.97–1.13) | |||||
65 to 79 years | 2.18 (2.05–2.33) | 2.30 (2.15–2.45) | 1.37 (1.28–1.47) | 1.57 (1.45–1.69) | |||||
80+ years | 5.15 (4.83–5.49) | 5.10 (4.77–5.45) | 2.69 (2.50–2.89) | 2.88 (2.66–3.11) | |||||
Gender | male | Reference | 0.614 | Reference | <0.001 | Reference | 0.001 | Reference | <0.001 |
female | 1.01 (0.98–1.03) | 0.75 (0.73–0.77) | 1.06 (1.02–1.09) | 0.84 (0.81–0.87) | |||||
Ethnicity | Caucasian | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
African-American | 1.03 (0.99–1.07) | 1.17 (1.13–1.22) | 1.19 (1.13–1.25) | 1.24 (1.18–1.30) | |||||
Other/Unknown | 0.70 (0.67–0.74) | 0.77 (0.73–0.81) | 0.81 (0.76–0.87) | 0.83 (0.78–0.89) | |||||
Marital status | Married | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 | Reference | <0.001 |
Single | 1.32 (1.27–1.37) | 1.46 (1.40–1.52) | 1.40 (1.33–1.47) | 1.41 (1.33–1.48) | |||||
Widowed | 2.21 (2.15–2.28) | 1.42 (1.37–1.46) | 1.91 (1.84–1.99) | 1.34 (1.28–1.40) | |||||
Other/Unknown | 1.25 (1.20–1.30) | 1.28 (1.23–1.33) | 1.21 (1.15–1.28) | 1.19 (1.13–1.26) |
Adjusting for patients characteristics with propensity score matching
Logistic regression in raw data (N = 91,4166)a
| Patient characteristics after stratified bipartite propensity score matching (N = 90,067)c
| ||||||
---|---|---|---|---|---|---|---|
OR (95 % CI) | Pb
| Total | Right-sided carcinoma | Left-sided carcinoma | Pb
| ||
N = 90,067 |
N = 51,331 |
N = 38,736 | |||||
Tumor stage | Stage I | D) | 24,924 (27.7 %) | 13,622 (26.5 %) | 11,302 (29.2 %) | E) | |
(AJCC 6th ed.) | Stage II | 33,002 (36.6 %) | 19,790 (38.6 %) | 13,212 (34.1 %) | |||
Stage III | 32,141 (35.7 %) | 17,919 (34.9 %) | 14,222 (36.7 %) | ||||
T-stage | T1 | Reference | <0.001 | 11387.4 (12.6 %) | 6378 (12.4 %) | 5009.4 (12.9 %) | 0.908 |
T2 | 1.45 (1.36–1.55) | 17213.6 (19.1 %) | 9360 (18.2 %) | 7853.6 (20.3 %) | |||
T3 | 1.15 (1.08–1.22) | 50984.6 (56.6 %) | 29,704 (57.9 %) | 21280.6 (54.9 %) | |||
T4 | 1.08 (1.00–1.17) | 10481.4 (11.6 %) | 5889 (11.5 %) | 4592.4 (11.9 %) | |||
Number of positive | 0 | Reference | <0.001 | 57,926 (64.3 %) | 33,412 (65.1 %) | 24,514 (63.3 %) | 0.733 |
Regional lymph | 1 | 0.82 (0.78–0.87) | 10303.2 (11.4 %) | 5579 (10.9 %) | 4724.2 (12.2 %) | ||
Nodes | 2–3 | 0.82 (0.77–0.86) | 9909.2 (11.0 %) | 5631 (11.0 %) | 4278.2 (11.0 %) | ||
4–6 | 0.87 (0.81–0.93) | 6433.9 (7.1 %) | 3650 (7.1 %) | 2783.9 (7.2 %) | |||
7+ | 0.94 (0.86–1.01) | 5494.7 (6.1 %) | 3059 (6.0 %) | 2435.7 (6.3 %) | |||
Number of retrieved | <12 | Reference | <0.001 | 18327.7 (20.3 %) | 10,240 (19.9 %) | 8087.7 (20.9 %) | 0.931 |
Regional lymph | 12–16 | 1.72 (1.64–1.80) | 25,713 (28.5 %) | 14,813 (28.9 %) | 10,900 (28.1 %) | ||
Nodes | 17+ | 2.44 (2.33–2.55) | 46026.3 (51.1 %) | 26,278 (51.2 %) | 19748.3 (51.0 %) | ||
Grading | G1 | Reference | <0.001 | 8274.1 (9.2 %) | 4667 (9.1 %) | 3607.1 (9.3 %) | 0.954 |
G2 | 0.97 (0.91–1.02) | 60851.4 (67.6 %) | 34,630 (67.5 %) | 26221.4 (67.7 %) | |||
G3 | 1.74 (1.62–1.87) | 16543.4 (18.4 %) | 9599 (18.7 %) | 6944.4 (17.9 %) | |||
G4 | 1.92 (1.64–2.24) | 1738.2 (1.9 %) | 1035 (2.0 %) | 703.2 (1.8 %) | |||
Unknown | 0.92 (0.82–1.03) | 2659.8 (3.0 %) | 1400 (2.7 %) | 1259.8 (3.3 %) | |||
Histology | Adenocarcinoma | Reference | <0.001 | 62172.7 (69.0 %) | 35,607 (69.4 %) | 26565.7 (68.6 %) | 0.978 |
Adeno-Ca in adenomatous polyp | 0.95 (0.89–1.02) | 5139.1 (5.7 %) | 2883 (5.6 %) | 2256.1 (5.8 %) | |||
Adeno-Ca in villous adenoma | 2.02 (1.82–2.25) | 2901.7 (3.2 %) | 1664 (3.2 %) | 1237.7 (3.2 %) | |||
Adeno-Ca in tubulovillous adenoma | 1.73 (1.62–1.85) | 8333.5 (9.3 %) | 4806 (9.4 %) | 3527.5 (9.1 %) | |||
Mucinous carcinoma | 2.23 (2.10–2.37) | 11,520 (12.8 %) | 6371 (12.4 %) | 5149 (13.3 %) | |||
CEA | C0-stage | Reference | <0.001 | 31640.5 (35.1 %) | 18,476 (36.0 %) | 13164.5 (34.0 %) | 0.763 |
C1-stage | 0.88 (0.83–0.92) | 17236.6 (19.1 %) | 9804 (19.1 %) | 7432.6 (19.2 %) | |||
Unknown/Borderline | 1.00 (0.96–1.04) | 41189.8 (45.7 %) | 23,051 (44.9 %) | 18138.8 (46.8 %) | |||
Operation | Segmental resection | Reference | <0.001 | 13557.3 (15.1 %) | 7750 (15.1 %) | 5807.3 (15.0 %) | 0.447 |
Hemi/subtotal colectomy | 14.3 (13.8–14.8) | 75781.8 (84.1 %) | 43,171 (84.1 %) | 32610.8 (84.2 %) | |||
Other | 2.66 (2.32–3.05) | 727.9 (0.8 %) | 410 (0.8 %) | 317.9 (0.8 %) | |||
Year | 2004 to 2006 | Reference | 0.285 | 31,052 (34.5 %) | 17,527 (34.1 %) | 13,525 (34.9 %) | E) |
2007 to 2009 | 0.97 (0.93–1.01) | 30,869 (34.3 %) | 17,585 (34.3 %) | 13,284 (34.3 %) | |||
2010 to 2012 | 0.97 (0.93–1.01) | 28,146 (31.3 %) | 16,219 (31.6 %) | 11,927 (30.8 %) | |||
Age | Up to 49 years | Reference | <0.001 | 5545.6 (6.2 %) | 3174 (6.2 %) | 2371.6 (6.1 %) | 0.995 |
50 to 64 years | 1.56 (1.46–1.66) | 21581.8 (24.0 %) | 12,332 (24.0 %) | 9249.8 (23.9 %) | |||
65 to 79 years | 2.65 (2.49–2.83) | 37577.3 (41.7 %) | 21,253 (41.4 %) | 16324.3 (42.1 %) | |||
80+ years | 4.08 (3.80–4.39) | 25362.3 (28.2 %) | 14,572 (28.4 %) | 10790.3 (27.9 %) | |||
Gender | male | Reference | <0.001 | 40730.6 (45.2 %) | 22,954 (44.7 %) | 17776.6 (45.9 %) | 0.570 |
female | 1.30 (1.26–1.35) | 49336.4 (54.8 %) | 28,377 (55.3 %) | 20959.4 (54.1 %) | |||
Ethnicity | Caucasian | Reference | <0.001 | 72714.5 (80.7 %) | 41,771 (81.4 %) | 30943.5 (79.9 %) | 0.050 |
African-American | 1.09 (1.04–1.15) | 11763.1 (13.1 %) | 6213 (12.1 %) | 5550.1 (14.3 %) | |||
Other/Unknown | 0.66 (0.62–0.70) | 5589.4 (6.2 %) | 3347 (6.5 %) | 2242.4 (5.8 %) | |||
Marital status | Married | Reference | 0.877 | 47284.7 (52.5 %) | 27,005 (52.6 %) | 20279.7 (52.4 %) | 0.930 |
Single | 0.98 (0.93–1.03) | 10609.8 (11.8 %) | 6044 (11.8 %) | 4565.8 (11.8 %) | |||
Widowed | 1.00 (0.95–1.05) | 20331.9 (22.6 %) | 11,580 (22.6 %) | 8751.9 (22.6 %) | |||
Other/Unknown | 0.99 (0.94–1.05) | 11840.6 (13.1 %) | 6702 (13.1 %) | 5138.6 (13.3 %) |