Survival of patients with symptom- and screening-detected colorectal cancer

Oncotarget. 2016 Jul 12;7(28):44695-44704. doi: 10.18632/oncotarget.9412.


Background: An increasing proportion of colorectal cancer (CRC) patients are diagnosed by screening rather than symptoms.

Aims: We aimed to assess and compare prognosis of patients with screen-detected CRC and symptom-detected CRC.

Methods: Overall and CRC specific mortality over a median follow-up of 4.8 years was assessed according to mode of diagnosis (symptoms, screening colonoscopy, fecal occult blood test [FOBT], other) in a multi-center cohort of 2,450 CRC patients aged 50-79 years recruited in Germany in 2003-2010.

Results: 68%, 11% and 10% were detected by symptoms, screening colonoscopy and FOBT, respectively. The screen-detected cancers had a more favorable stage distribution than the symptom-detected cancers (68% versus 50% in stage I or II). Age- and sex adjusted hazard ratios (HRs) of total mortality with 95% confidence intervals (95% CIs) compared to symptom-detected cancers were 0.35 (0.24-0.50) and 0.36 (0.25-0.53) for screening colonoscopy and FOBT detected CRCs, respectively. HRs were only slightly attenuated and remained highly significant after adjustment for stage and multiple other covariates (0.50 (0.34-0.73) and 0.54 (0.37-0.80), respectively). Even stronger associations were seen for CRC specific mortality. Patients with screen-detected stage III CRC had as good CRC specific survival as patients with symptom-detected stage I or II CRC.

Conclusions: Patients with screen-detected CRC have a very good prognosis far beyond the level explained by their more favorable stage distribution. Mode of detection is an important, easy-to-obtain proxy indicator for favorable diagnosis beyond earlier stage at diagnosis and as such may be useful for risk stratification in treatment decisions.

Keywords: colonoscopy; colorectal cancer; fecal occult blood test; screening; survival.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cohort Studies
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / mortality
  • Early Detection of Cancer / methods*
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Germany
  • Humans
  • Male
  • Mass Screening / methods*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Occult Blood
  • Prognosis
  • Proportional Hazards Models
  • Survival Analysis
  • Survival Rate