The National Cancer Data Base report on patterns of care for adenocarcinoma of the rectum, 1985-95.

BACKGROUND

The Commission on Cancer data from the National Cancer Data Base (NCDB) examining current time trends (1985-1995) in stage of disease, treatment patterns, and survival relating to patients with rectal adenocarcinoma are described in this report.

METHODS

Seven calls for data to hospital cancer registries across the U.S. have yielded a total of 5,850,000 cancer cases for the years 1985-1995 and include 20,461 rectal and rectosigmoid junction adenocarcinoma cases in 1985-1986, 36,007 cases in 1989-1990, and 42,069 cases in 1994-1995. These data represent 24.4%, 44.5%, and 52.5%, respectively, of the estimated cases of rectal and rectosigmoid adenocarcinoma cases diagnosed in the U.S. in each of the 3 respective time periods. Analysis of the data is limited to cases with American Joint Committee on Cancer (AJCC) Stage I-IV disease.

RESULTS

Four trends were observed. 1) Stage I disease was diagnosed with decreasing frequency, decreasing from 37.1% of cases with known AJCC stage of disease in 1985-1986 to 33.8% in 1994-1995. 2) There was an increase in the frequency with which local excision was utilized as all or part of the primary treatment for Stage I disease. 3) Stage for stage, there was an increase in the frequency with which anterior/posterior resections were utilized and a corresponding decline in the use of abdominoperineal resections. 4) Multimodal treatment regimens are being used with greater frequency, particularly in patients with Stage II and III disease.

CONCLUSIONS

The NCDB data have important implications for analyzing cancer treatment and outcome in the U.S. These data suggest that rectal adenocarcinoma is being diagnosed at a later stage, especially among the young and African Americans. The guidelines for colorectal carcinoma screening issued by the American Cancer Society and the American Gastroenterological Association should be promoted more vigorously to increase the proportion of patients presenting with early stage disease and improve overall survival. The increased use of multimodal therapy for the treatment of Stage II and III disease continues.