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CC BY 4.0 · Endoscopy 2024; 56(01): 5-13
DOI: 10.1055/a-2173-5989
Original article

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Esther Toes-Zoutendijk  ‡   ‡
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Emilie C. H. Breekveldt‡   ‡
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
2   Department of Gastrointestinal Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
,
Lisa van der Schee
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Iris D. Nagtegaal
4   Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Marloes A. G. Elferink
5   Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
,
Iris Lansdorp-Vogelaar
1   Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Leon M. G. Moons
3   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Monique E. van Leerdam
2   Department of Gastrointestinal Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
6   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Correction: Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening programEndoscopy eFirst
DOI: 10.1055/a-2217-6054

Abstract

Background Screen-detected colorectal cancers (CRCs) are often treated less invasively than stage-matched non-screen-detected CRCs, but the reasons for this are not fully understood. This study evaluated the treatment of stage I CRCs detected within and outside of the screening program in the Netherlands.

Methods Data from the Netherlands Cancer Registry for all stage I CRCs diagnosed between January 1, 2008 and December 31, 2020 were analyzed, comparing patient, tumor, and treatment characteristics of screen-detected and non-screen-detected stage I CRCs. Multivariable logistic regression was used to assess the association between treatment (local excision only vs. surgical oncologic resection) and patient and tumor characteristics, stratified for T stage and tumor location.

Results Screen-detected stage I CRCs were relatively more often T1 than T2 compared with non-screen-detected stage I CRCs (66.9 % vs. 53.3 %; P < 0.001). When only T1 tumors were considered, both screen-detected colon and rectal cancers were more often treated with local excision only than non-screen-detected T1 cancers (odds ratio [OR] 2.19, 95 %CI 1.93–2.49; and OR 1.29, 95 %CI 1.05–1.59, respectively), adjusted for sex, tumor location, lymphovascular invasion (LVI) status, and tumor differentiation.

Conclusions Less invasive treatment of screen-detected stage I CRC is partly explained by the higher rate of T1 cancers compared with non-screen-detected stage I CRCs. T1 stage I screen-detected CRCs were also more likely to undergo less invasive treatment than non-screen-detected CRCs, adjusted for risk factors such as LVI and tumor differentiation. Future research should investigate whether the choice of local excision was related to unidentified cancer-related factors or the expertise of the endoscopists.

‡ Joint first authors


Table 1 s



Publication History

Received: 10 March 2023

Accepted: 17 August 2023

Article published online:
07 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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