Twenty Years of Modern Rectal Cancer Care in Lithuania: Stage Migration, Evolving Treatment Patterns, and Improved Survival at a Tertiary Referral Centre.
6 affiliations
- 1Department of Oncology and Hematology, Institute of Oncology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania.
- 2Department of Oncology and Hematology, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, LT-50161 Kaunas, Lithuania.
- 3Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
- 4Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
- 5Department of Pathology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
- 6Faculty of Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Abstract
Background and Objectives: Rectal cancer management has changed substantially over the past two decades. We evaluated 20-year trends in stage at diagnosis, treatment patterns, and survival at a Lithuanian tertiary referral centre. Materials and Methods: This retrospective cohort study included 839 patients who underwent resection for stage I-III rectal cancer between 2004 and 2023, divided into two periods: 2004-2013 (n = 426) and 2014-2023 (n = 413). Survival was analysed with Kaplan-Meier estimates and Cox proportional hazards regression, truncated at 60 months. Results: Patients in the later cohort were diagnosed at an earlier clinical stage (stage I: 12.6% vs. 2.4%) and more often received neoadjuvant or perioperative therapy (55.2% vs. 37.1%; p < 0.001). Among clinical stage III patients, receipt of neoadjuvant chemoradiotherapy or total neoadjuvant treatment rose from 15.9% to 70.9% (p < 0.001), while pathological complete response among treated patients remained stable (10.8% vs. 10.7%; p = 0.98). Five-year overall survival increased from 64.8% to 71.3% (HR 0.77; 95% CI 0.60-0.99; p = 0.039) and cancer-specific survival from 70.4% to 80.8% (HR 0.60; 95% CI 0.45-0.80; p = 0.0005). The cohort effect persisted after multivariable adjustment for CSS (HR 0.62; 95% CI 0.45-0.85; p = 0.003), with clinical stage explaining only ~13% of the crude effect; stage III sensitivity analysis confirmed the CSS gain (67.9% to 77.3%; p = 0.009). Conclusions: Cancer-specific survival improved substantially and independently of stage migration. The gain coincided with markedly wider and better-targeted delivery of effective neoadjuvant therapy rather than with improved per-patient tumour responsiveness. As an observational comparison of two historical cohorts, this study demonstrates association rather than causation; nonetheless, it provides real-world evidence consistent with the hypothesis that systematic implementation of evidence-based rectal cancer pathways translates into measurable survival benefit.
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BibTeX
@article{ambraziene2026twenty,
title = {{Twenty Years of Modern Rectal Cancer Care in Lithuania: Stage Migration, Evolving Treatment Patterns, and Improved Survival at a Tertiary Referral Centre.}},
author = {Rita Ambraziene and Laura Kairevice and Lina Puzauskiene and Greta Chlebopaseviene and Algimantas Tamelis and Tadas Latkauskas and Henrikas Pauzas and Irina Gineikiene and Ingrida Pikuniene and Laimonas Jarusevicius and Vita Simonyte-Verbickiene and Dainius Janciauskas and Egle Butnoriute and Emilija Jaceviciute and Rasa Janciauskiene},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = sep,
doi = {10.3390/medicina62101888},
url = {https://europepmc.org/article/MED/42942419},
note = {CC BY},
}
RIS
TY - JOUR
TI - Twenty Years of Modern Rectal Cancer Care in Lithuania: Stage Migration, Evolving Treatment Patterns, and Improved Survival at a Tertiary Referral Centre.
AU - Rita Ambraziene
AU - Laura Kairevice
AU - Lina Puzauskiene
AU - Greta Chlebopaseviene
AU - Algimantas Tamelis
AU - Tadas Latkauskas
AU - Henrikas Pauzas
AU - Irina Gineikiene
AU - Ingrida Pikuniene
AU - Laimonas Jarusevicius
AU - Vita Simonyte-Verbickiene
AU - Dainius Janciauskas
AU - Egle Butnoriute
AU - Emilija Jaceviciute
AU - Rasa Janciauskiene
PY - 2026
DA - 2026/09/29
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101888
UR - https://europepmc.org/article/MED/42942419
AB - Background and Objectives: Rectal cancer management has changed substantially over the past two decades. We evaluated 20-year trends in stage at diagnosis, treatment patterns, and survival at a Lithuanian tertiary referral centre. Materials and Methods: This retrospective cohort study included 839 patients who underwent resection for stage I-III rectal cancer between 2004 and 2023, divided into two periods: 2004-2013 (n = 426) and 2014-2023 (n = 413). Survival was analysed with Kaplan-Meier estimates and Cox proportional hazards regression, truncated at 60 months. Results: Patients in the later cohort were diagnosed at an earlier clinical stage (stage I: 12.6% vs. 2.4%) and more often received neoadjuvant or perioperative therapy (55.2% vs. 37.1%; p < 0.001). Among clinical stage III patients, receipt of neoadjuvant chemoradiotherapy or total neoadjuvant treatment rose from 15.9% to 70.9% (p < 0.001), while pathological complete response among treated patients remained stable (10.8% vs. 10.7%; p = 0.98). Five-year overall survival increased from 64.8% to 71.3% (HR 0.77; 95% CI 0.60-0.99; p = 0.039) and cancer-specific survival from 70.4% to 80.8% (HR 0.60; 95% CI 0.45-0.80; p = 0.0005). The cohort effect persisted after multivariable adjustment for CSS (HR 0.62; 95% CI 0.45-0.85; p = 0.003), with clinical stage explaining only ~13% of the crude effect; stage III sensitivity analysis confirmed the CSS gain (67.9% to 77.3%; p = 0.009). Conclusions: Cancer-specific survival improved substantially and independently of stage migration. The gain coincided with markedly wider and better-targeted delivery of effective neoadjuvant therapy rather than with improved per-patient tumour responsiveness. As an observational comparison of two historical cohorts, this study demonstrates association rather than causation; nonetheless, it provides real-world evidence consistent with the hypothesis that systematic implementation of evidence-based rectal cancer pathways translates into measurable survival benefit.
SN - 1010-660X
SN - 1648-9144
ER -