Survival following early-stage colon cancer: An ACCENT-based comparison of patients versus a matched international general population

for the Adjuvant Colon Cancer Endpoints (ACCENT) Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. Patients and methods: A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. Results: Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. Conclusions: Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.

Original languageEnglish (US)
Pages (from-to)950-958
Number of pages9
JournalAnnals of Oncology
Volume26
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Colonic Neoplasms
Survival
Population
oxaliplatin
Recurrence
Fluorouracil
Survival Rate
Quality of Health Care
Random Allocation
Therapeutics
Clinical Trials

Keywords

  • Early-stage colon cancer
  • Individual patient data
  • Long-term survival
  • Meta-analysis
  • Oxaliplatin chemotherapy
  • Population

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

@article{4f67e7e0693a41e49e2197dc97373b9b,
title = "Survival following early-stage colon cancer: An ACCENT-based comparison of patients versus a matched international general population",
abstract = "Background: Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. Patients and methods: A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. Results: Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5{\%} of the MGP, with recurrence-free patients achieving equivalence. Conclusions: Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.",
keywords = "Early-stage colon cancer, Individual patient data, Long-term survival, Meta-analysis, Oxaliplatin chemotherapy, Population",
author = "{for the Adjuvant Colon Cancer Endpoints (ACCENT) Group} and Renfro, {Lindsay A.} and A. Grothey and D. Kerr and Haller, {D. G.} and T. Andr{\'e} and {Van Cutsem}, E. and L. Saltz and R. Labianca and Loprinzi, {C. L.} and Alberts, {S. R.} and H. Schmoll and C. Twelves and G. Yothers and Sargent, {D. J.} and Sargent, {D. J.} and E. Green and Alberts, {S. R.} and Q. Shi and Renfro, {L. A.} and G. Yothers and O'Connell, {M. J.} and N. Wolmark and Gramont, {A. de} and R. Gray and D. Kerr and Haller, {D. G.} and K. Guthrie and M. Buyse and Seitz, {J. F.} and O'Callaghan, {C. J.} and G. Francini and Catalano, {P. J.} and Blanke, {C. D.} and T. Andre and Goldberg, {R. M.} and {Benson III}, {Al B} and F. Sirzen and L. Cisar and Cutsem, {E. Van}",
year = "2015",
month = "5",
day = "1",
doi = "10.1093/annonc/mdv073",
language = "English (US)",
volume = "26",
pages = "950--958",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
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}

Survival following early-stage colon cancer : An ACCENT-based comparison of patients versus a matched international general population. / for the Adjuvant Colon Cancer Endpoints (ACCENT) Group.

In: Annals of Oncology, Vol. 26, No. 5, 01.05.2015, p. 950-958.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival following early-stage colon cancer

T2 - An ACCENT-based comparison of patients versus a matched international general population

AU - for the Adjuvant Colon Cancer Endpoints (ACCENT) Group

AU - Renfro, Lindsay A.

AU - Grothey, A.

AU - Kerr, D.

AU - Haller, D. G.

AU - André, T.

AU - Van Cutsem, E.

AU - Saltz, L.

AU - Labianca, R.

AU - Loprinzi, C. L.

AU - Alberts, S. R.

AU - Schmoll, H.

AU - Twelves, C.

AU - Yothers, G.

AU - Sargent, D. J.

AU - Sargent, D. J.

AU - Green, E.

AU - Alberts, S. R.

AU - Shi, Q.

AU - Renfro, L. A.

AU - Yothers, G.

AU - O'Connell, M. J.

AU - Wolmark, N.

AU - Gramont, A. de

AU - Gray, R.

AU - Kerr, D.

AU - Haller, D. G.

AU - Guthrie, K.

AU - Buyse, M.

AU - Seitz, J. F.

AU - O'Callaghan, C. J.

AU - Francini, G.

AU - Catalano, P. J.

AU - Blanke, C. D.

AU - Andre, T.

AU - Goldberg, R. M.

AU - Benson III, Al B

AU - Sirzen, F.

AU - Cisar, L.

AU - Cutsem, E. Van

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. Patients and methods: A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. Results: Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. Conclusions: Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.

AB - Background: Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. Patients and methods: A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. Results: Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. Conclusions: Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.

KW - Early-stage colon cancer

KW - Individual patient data

KW - Long-term survival

KW - Meta-analysis

KW - Oxaliplatin chemotherapy

KW - Population

UR - http://www.scopus.com/inward/record.url?scp=84929083369&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929083369&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdv073

DO - 10.1093/annonc/mdv073

M3 - Article

C2 - 25697217

AN - SCOPUS:84929083369

VL - 26

SP - 950

EP - 958

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 5

ER -