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Survival trends for advanced colorectal cancer (CRC): Are improvements only for patients in clinical trials?

6124 Background: Significant improvements in the outcome for patients with advanced CRC have been achieved. We have reviewed the prospective CRC database at our institution from 1992 to 2004 to explore whether the availability of new chemotherapy drugs (irinotecan & oxaliplatin) and surgical advances has impacted on survival in the normal population. Earlier results had suggested a trend to improved survival (1).


METHODS
In Australia the first of these drugs became available at the end of 1997 thus we have taken this as the time point to compare outcomes pre and post. Disease-specific survivals were analysed from the date of diagnosis for stage D, and from the date of distant recurrence for stages A, B and C, with a date of censoring of live cases at December 31st, 2004. The Kaplan-Meier product-limit estimate was used for univariate analyses and Cox proportional hazards regression for multivariable analyses.


RESULTS
The current analysis is of 744 patients; 92-97 n=313, 98-04 n=431. Survival for the respective time periods were 47.6% and 54.9% 12 mths; 28.0% and 34.8% 24 mths; 18.9% and 23.0% 36 mths; 12.6% and 17.2% 48 mths; and 10.4% and 14.9% 60 mths. Cox proportional hazards regression indicated a lower risk of case fatality for 1998-2004 than 1992-1997 cases (p=0.048) after adjusting for age measured in years. The key predictors of case fatality in a multivariate analysis were found to be period (i.e., 1992-97/1998-04), age, and stage of disease at time of initial diagnosis. While an upward trend in survival was recorded for all ages, it was most pronounced for 70-79 year olds (n=272), where the increase in 24 mth survival was from 21.1% for 1992-97 to 36.1% for 1998-2004 (p=0.015). For patients aged 80 years and over (1992-97 n=40 & 1998-2004 n=67) the 24mth survivals were 18.6% (6.7%) and 26.4% (6.9%) respectively (p>0.200).


CONCLUSIONS
Clinical trials have shown improvements in survival for highly selected patients. This current analysis confirms an improvement in survival over time for advanced CRC and this is seen in unselected patients including the elderly. Preliminary data has suggested that a number of factors have contributed to the trend of improved survival. Final analysis, including updated chemotherapy trends, will be presented at the meeting. (1) Proc ASCO 2004, #3707 No significant financial relationships to disclose.