Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

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I_will_fight
Posts: 148
Joined: Mon Jun 29, 2020 3:38 pm

Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby I_will_fight » Sun Mar 10, 2024 4:44 am

Hi all,

Many here are anxious about the possibility of recurrence. I hope this study helps a bit. Specially useful to put older and newer statistics into perspective.

This study from Danemark compares recurrence rates between patients treated in different calendar periods (2004-2008, 2009-2013, and 2014-2019) stratified by tumor site (colon or rectum) and stage (I, II, and III).

This study shows extraordinary improvement in the last 20 years:

For colon cancer, the 5-year cumulative incidence (CIF) of recurrence decreased over the 3 calendar periods from 16.3% to 6.8% for UICC stage I, from 21.9% to 11.6% for UICC stage II, and from 35.3% to 24.6% for UICC stage III colon cancer. For rectal cancer, the 5-year CIF decreased over the 3 periods from 19.9% to 9.5% for stage I, from 25.8% to 18.4% for stage II, and from 38.7% to 28.8% for stage III disease.

Image

Not sure what may have caused this remarkable improvement, I guess this reflects the improved surgical techniques and the widespread use of chemo/radio? Also makes you wonder if the results in Danemark can be extrapolated to other countries.

https://jamanetwork.com/journals/jamaon ... le/2812113

Of note: Danish follow up seems to be pretty relaxed with imaging checkup points at 12 and 36 months only.

Image
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

saltygirl
Posts: 169
Joined: Sun Feb 07, 2021 4:46 pm
Facebook Username: Salty.girl

Re: Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby saltygirl » Sun Mar 10, 2024 3:45 pm

I was unfortunately the stage 1 that progressed to stage 4. Had very aggressive treatment. 3 years NED now.
Stage 4, distant lymph nodes May 2020, braf/kras mutations
11 folfoxiri
Intense radiation 1 week on distant lymph nodes
Surgery, hysterectomy, colon resection, distant lymph nodes resection
Complete pathological response to chemo.
NED 2021
NED 2022
NED 2023

I_will_fight
Posts: 148
Joined: Mon Jun 29, 2020 3:38 pm

Re: Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby I_will_fight » Mon Mar 11, 2024 12:00 am

saltygirl wrote:I was unfortunately the stage 1 that progressed to stage 4. Had very aggressive treatment. 3 years NED now.


Sorry to hear that you progressed but happy that you have been NED for 3 years.

May I ask you how long between surgery and progression to stage 4?

Good luck
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

saltygirl
Posts: 169
Joined: Sun Feb 07, 2021 4:46 pm
Facebook Username: Salty.girl

Re: Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby saltygirl » Mon Mar 11, 2024 12:15 pm

Almost 5 years. I believe especially young patients we don't fit statistics. We are not even suppose to have this type of cancer. I was 39 stage 1. 44 during covid stage 4. My tumor grew within a year to almost 10 cm with involving my ovary and distant lymph nodes. Life is good now. Heading to Dubai and Maldives this week.
Stage 4, distant lymph nodes May 2020, braf/kras mutations
11 folfoxiri
Intense radiation 1 week on distant lymph nodes
Surgery, hysterectomy, colon resection, distant lymph nodes resection
Complete pathological response to chemo.
NED 2021
NED 2022
NED 2023

User avatar
Green Tea
Posts: 461
Joined: Mon Oct 24, 2016 10:48 am

Re: Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby Green Tea » Mon Mar 11, 2024 4:58 pm

Thanks for posting information on this study, and for the graphs. Very interesting! This suggests to me that there may be some changes in Standard of Care that have triggered new survival statistics.

Does anyone have information on changes in CRC standards of care over the past 10 to 20 years?

I_will_fight
Posts: 148
Joined: Mon Jun 29, 2020 3:38 pm

Re: Interesting (and optimistic) danish study on recurrence for stage I-III colorectal cancer

Postby I_will_fight » Tue Mar 12, 2024 5:38 am

Green Tea wrote:Thanks for posting information on this study, and for the graphs. Very interesting! This suggests to me that there may be some changes in Standard of Care that have triggered new survival statistics.

Does anyone have information on changes in CRC standards of care over the past 10 to 20 years?


I think there might be a few, this is all especulation but hopefully not totally incorrect.

1 - better surgery: Total Mesorectal Excision (TME) for rectal cancer and Complete Mesocolic Excision (CME) for colon cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678385/

2 - The above has led to increased lymph node yield, this has mitigated the risk of understaging many patientes (which would be staged as I or II and thus not offered chemotherapy when they might have been stage III)

3- generalised prescription of chemo "doublets"

4 - Inmunotherapy?

5- emphasis on nutrition, exercise and stress management?

6- There may be many other things, like patients being younger now than 20 years ago...
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT


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