Ciccolallo L et al. (2005) Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery. Gut 54: 268–273

Colorectal cancer survival rates are markedly lower in Europe than in the US. Ciccolallo et al. have explored the reasons behind this variation using population-based registry data.

Ten European cancer registries provided details of 2,492 consecutive cases of primary invasive adenocarcinoma of the large bowel diagnosed in 1990–1991. Data on a further 11,191 cases were extracted from the SEER database in the US. In addition to details of surgical treatment, the information included disease stage and number of examined lymph nodes as a determinant of staging accuracy.

As expected, 3-year relative survival was significantly higher in the US (69%) than in Europe (57%). In all European registries except Modena and Eindhoven, the crude relative excess risk of death was significant, ranging from 1.26 to 2.21. Patients in the US were more likely to be diagnosed with localized disease and to undergo surgical resection than their European counterparts (54% vs 48% and 92% vs 85%, respectively). In addition, examination of 12 or more lymph nodes was more common in the US. It should be noted that data from the individual European registries varied widely; the rates of localized disease among patients from the Dutch registries, for example, were higher than those in the US.

The study highlights the differences in the diagnosis and treatment of colorectal cancer in Europe and the US, and indicates that differences in the stage at diagnosis are largely responsible for the variation in survival rates between these two populations.