|
|
Back to 2014 Annual Meeting Posters
Time Trends and Relation of Stage and Tumor Size At Diagnosis in Gastrointestinal Cancer - a SEER Database Analysis With 496,051 Patients
Attila Dubecz*1, Norbert Solymosi2, Michael Schweigert1, Rudolf J. Stadlhuber1, Jeffrey H. Peters3, Hubert J. Stein1
1Surgery, Klinikum Nürnberg, Nuremberg, Germany; 2Department of the Physics of Complex Systems, Eötvös Loránd University, Budapest, Hungary; 3Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
BACKGROUND
Widespread use of modern imaging techniques and screening programmes
promise the detection of malignant disease at a smaller size and in an earlier, more curable stage but their effect in reducing the incidence of advanced disease is controversial. Our objective was to evaluate the time trends of tumor size at diagnosis in gastrointestinal (GI) cancer, assess the relationship of tumor size and stage and identify factors associated with an early diagnosis in a large population-based sample.
METHODS
Using the National Cancer Institute's Surveillance Epidemiology and End Results Database (1997-2010), a total of 496,051 patients with histologically proven GI malignancy (esophagus: 20,012; stomach: 37,958; colon: 285,859; rectum: 58,465; liver: 29233; pancreas: 60,016, gallbladder: 4,508) were identified. Tumor size at diagnosis and incidence of early stage and advanced disease for each cancer type were assessed and trended over the study period. Multivariate logistic regression was employed to identify factors predicting an early diagnosis, defined as tumor size <10mm.
RESULTS
While median size of tumors at diagnosis decreased over the two decades of study in most types of GI cancer (esophagus: from 50 to 45 mm; stomach: 50-40 mm; colon: 43-42 mm; rectum: 40-35 mm; liver: 60-62 mm, gall bladder: 30-35 mm and pancreas: 40-36 mm), the incidence of advanced stage disease increased in all gastrointestinal malignancies (esophagus: from 6.4 to 12.5 / 100,000; stomach: 15.3-17.6 / 100,000; colon: 109.8-111.6 / 100,000; rectum: 16.1-23.2 / 100,000; liver: 4.4-12.7 / 100,000, gall bladder: 1.1-2.6 / 100,000 and pancreas: 18.6-53.9 / 100,000). Eighty-five percent of patiens diagnosed with a GI tumor smaller than 10mm had early stage disease (esophagus: 73%; stomach: 84%; colon: 88%; rectum: 92%; liver: 76%, gall bladder: 78% and pancreas: 44%). Proportion of patients diagnosed with a tumor smaller than 10mm remained <10% in all types of GI maligancy (except in patients with rectal cancer: 16%) even in 2010. Elderly white patients, those diagnosed earlier in the study period and living in areas with lower poverty rates were significantly less likely to be diagnosed with a tumor smaller than 1cm (all p<0.01).
CONCLUSIONS
Tumor size correllates with the distribution of stages in GI cancer: smaller lesions represent earlier stage disease. Despite considerable decreases in the median size of gastrointestinal tumors detected, this has not reduced the rate at which patients present with advanced disease. Further improvements are needed in early detection of GI malignancies.
Back to 2014 Annual Meeting Posters
|
