"What if I do nothing?” The Natural History of Operable Cancer of the Alimentary Tract

Publication date: Available online 18 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Hari B. Keshava, Joshua E. Rosen, Matthew R. DeLuzio, Anthony W. Kim, Frank C. Detterbeck, Daniel J. Boffa
Introduction"Natural history", or anticipated survival without treatment, is critical for patients weighing risks and benefits of cancer surgery. Current estimates concerning the natural history of cancer includes patients whose poor health precludes treatment; a cohort whose fate is likely distinctly worse than those eligible for surgery ("operable"). The study objective was to evaluate survival among patients recommended for cancer surgery but went untreated, to determine the natural history of "operable" alimentary tract cancer.MethodsThe NCDB was queried for untreated patients with clinical stage I-III esophageal, gastric, colon, and rectal cancer diagnosed between 2003-2009. Untreated patients who were recommended for surgery were considered "operable," while patients coded as surgically ineligible for health reasons were "inoperable."Results5-year survival of untreated, "operable" alimentary tract cancers varied by clinical stage: esophageal cI=10.0%, cII=9.8%, cIII=4.6%; gastric cI=9.2%, cII=5.8%, cIII=4.3%; colon cI=18.4%, cII=5.0%, cIII=10.4; and rectal cI=17.1%, cII=14.0%, cIII=19.9%. At every timepoint, stage-specific survival of "operable" patients was superior to inoperable patients (p<0.05). Additionally, median survival among "operable" patients at least doubled "inoperable" patients for each tumor.ConclusionNatural history of patients with "operable" alimentary tract cancer is superior to that of "inoperable" patients. Preoperative counseling should be refined to reflect this distinction.

Teaser

Synopsis: The natural history of operable primary cancers of the alimentary tract is unknown. The National Cancer Database was queried for untreated patients with esophageal, gastric, colon, or rectal cancer with a surgical recommendation (operable). While poor, survival for patients with operable cancers is greater than those without surgical recommendation (inoperable).


http://ift.tt/2iXc7ih