Maximilian Richter, Lena Sonnow*, Amir Mehdizadeh-Shrifi, Axel Richter, Rainer Kochand Alexander Zipprich

German oncology certification system for colorectal cancer–relative survival rates of a single certified centre vs. national and international registry data
Received January 6, 2021; accepted March 14, 2021;
published online April 28, 2021


Objectives: To evaluate how the certification of specialised Oncology Centres in Germany affects the relative survival of patients with colorectal cancer (CRC) by means of national and international comparison.

Methods: Between 2007 and 2013, 675 patients with colorectal cancer, treated at the Hildesheim Hospital, an academic teaching hospital of the Hannover Medical School (MHH), were included.

A follow-up of the entire patient group was performed until 2014. To obtain inter-national data, a SEER-database search was done. There lative survival of 148,957 patients was compared to our data after 12, 36 and 60 months. For national survival data, we compared our rates with 41,988 patients of theMunich Cancer Registry (MCR).

Results: Relative survival at our institution tends to be higher in advanced tumor stages compared to national and international cancer registry data. Nationally we found only little variation in survival rates for low stages CRC (UICC Iand II), colon, and rectal cancer. There were notable variations regarding relative survival rates for advanced CRC tumor stages (UICC IV). These variations were even more distinct for rectal cancer after 12, 36 and 60 months (Hildesheim Hospital: 89.9, 40.3, 30.1%; Munich Cancer Registry(MCR): 65.4, 28.7, 16.6%). The international comparison ofCRC showed significantly higher relative survival rates for patients with advanced tumor stages after 12 months at our institution (77 vs. 54.9% for UICC IV; raw p<0.001).

Conclusions: Our findings suggest that patients with advanced tumor stages of CRC and especially rectal cancer benefit most from a multidisciplinary and guidelines-oriented treatment at Certified Oncology Centres. For abetter evaluation of cancer treatment and improved national and international comparison, the creation of a centralised national cancer registry is necessary.


Colorectal cancer (CRC) is the third most common cancer in men and the second in women worldwide. Between one and two million cases are diagnosed every year [1].Furthermore, it is also one of the leading causes for cancer-related deaths worldwide alongside lung cancer and breast cancer [2, 3]. In Germany, the 5-year-prevalence for CRC(ICD-10, C18-21) was 116,000 among men and 98,000among women in 2013 [4]. Moreover, there was an increase of 38% in the 5-year-prevalence rate for women and 79% in men between 1990 and 2004 in Germany [4]. The GermanRobert Koch Institute (RKI) estimated the age-standardised incidence rate of CRC at approximately 63,000 cases in2014; 35,000 among men and 28,000 among women [4]. Therefore, a more integrative and multidisciplinary approach with optimised clinical pathways is necessary to successfully handle the rising numbers of CRC. There are various studies suggesting that patients may benefit from cancer treatment in specialised and centralised institutions, which are often referred to as high-volume hospitals [5–9].Taking the above mentioned into consideration, the German government implemented political measures to support the development of centralised cancer care. In 2008, the national cancer plan was initiated by German cancer societies including the German Cancer Society (DKG) and the Federal Ministery of Health (BMG). Four goals were set: reducing cancer-specific mortality through screening programmes, treatment decisions should be made according to evidence-based guidelines in order to maintain quality assurance, efficient oncological treatment should be associated with the collaboration of federal cancer registries, increased patient orientation should improve the quality of oncological care [10]. We aimed to analyse the importance of the German certification system and its benefits for long-term patient survival. We also intended to solidify the necessity for integrative patient treatment and a multidisciplinary centralised approach for CRC.