ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer

The Adjuvant Colon Cancer Endpoints (ACCENT) Group, Daniel J. Sargent

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background Current prognostic tools in colon cancer use relatively few patient characteristics. We constructed and validated clinical calculators for overall survival (OS) and time to recurrence (TTR) for stage III colon cancer and compared their performance against an existing tool (Numeracy) and American Joint Committee on Cancer (AJCC) version 7 staging. Methods Data from 15936 stage III patients accrued to phase III clinical trials since 1989 were used to construct Cox models for TTR and OS. Variables included age, sex, race, body mass index, performance status, tumor grade, tumor stage, ratio of positive lymph nodes to nodes examined, number and location of primary tumors, and adjuvant treatment (fluoropyrimidine single agent or in combination). Missing data were imputed, and final models internally validated for optimism-corrected calibration and discrimination and compared with AJCC. External validation and comparisons against Numeracy were performed using stage III patients from NSABP trial C-08. All statistical tests were two-sided. Results All variables were statistically and clinically significant for OS prediction, while age and race did not predict TTR. No meaningful interactions existed. Models for OS and TTR were well calibrated and associated with C-indices of 0.66 and 0.65, respectively, compared with C-indices of 0.58 and 0.59 for AJCC. These tools, available online, better predicted patient outcomes than Numeracy, both overall and within patient subgroups, in external validation. Conclusions The proposed ACCENT calculators are internally and externally valid, better discriminate patient risk than AJCC version 7 staging, and better predict patient outcomes than Numeracy. These tools have replaced Numeracy for online clinical use and will aid prognostication and patient/physician communication.

Original languageEnglish (US)
Article numberdju333
JournalJournal of the National Cancer Institute
Volume106
Issue number12
DOIs
StatePublished - Dec 1 2014

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Colonic Neoplasms
Recurrence
Survival
Neoplasms
Phase III Clinical Trials
Proportional Hazards Models
Calibration
Body Mass Index
Lymph Nodes
Communication
Physicians

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer. / The Adjuvant Colon Cancer Endpoints (ACCENT) Group; Sargent, Daniel J.

In: Journal of the National Cancer Institute, Vol. 106, No. 12, dju333, 01.12.2014.

Research output: Contribution to journalArticle

The Adjuvant Colon Cancer Endpoints (ACCENT) Group ; Sargent, Daniel J. / ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer. In: Journal of the National Cancer Institute. 2014 ; Vol. 106, No. 12.
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title = "ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer",
abstract = "Background Current prognostic tools in colon cancer use relatively few patient characteristics. We constructed and validated clinical calculators for overall survival (OS) and time to recurrence (TTR) for stage III colon cancer and compared their performance against an existing tool (Numeracy) and American Joint Committee on Cancer (AJCC) version 7 staging. Methods Data from 15936 stage III patients accrued to phase III clinical trials since 1989 were used to construct Cox models for TTR and OS. Variables included age, sex, race, body mass index, performance status, tumor grade, tumor stage, ratio of positive lymph nodes to nodes examined, number and location of primary tumors, and adjuvant treatment (fluoropyrimidine single agent or in combination). Missing data were imputed, and final models internally validated for optimism-corrected calibration and discrimination and compared with AJCC. External validation and comparisons against Numeracy were performed using stage III patients from NSABP trial C-08. All statistical tests were two-sided. Results All variables were statistically and clinically significant for OS prediction, while age and race did not predict TTR. No meaningful interactions existed. Models for OS and TTR were well calibrated and associated with C-indices of 0.66 and 0.65, respectively, compared with C-indices of 0.58 and 0.59 for AJCC. These tools, available online, better predicted patient outcomes than Numeracy, both overall and within patient subgroups, in external validation. Conclusions The proposed ACCENT calculators are internally and externally valid, better discriminate patient risk than AJCC version 7 staging, and better predict patient outcomes than Numeracy. These tools have replaced Numeracy for online clinical use and will aid prognostication and patient/physician communication.",
author = "{The Adjuvant Colon Cancer Endpoints (ACCENT) Group} and Renfro, {Lindsay A.} and Grothey, {Axel F} and Yuan Xue and Saltz, {Leonard B.} and Thierry Andr{\'e} and Chris Twelves and Roberto Labianca and Allegra, {Carmen J.} and Alberts, {Steven Robert} and Loprinzi, {Charles Lawrence} and Sargent, {Daniel J.} and Sargent, {Daniel J.}",
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T1 - ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer

AU - The Adjuvant Colon Cancer Endpoints (ACCENT) Group

AU - Renfro, Lindsay A.

AU - Grothey, Axel F

AU - Xue, Yuan

AU - Saltz, Leonard B.

AU - André, Thierry

AU - Twelves, Chris

AU - Labianca, Roberto

AU - Allegra, Carmen J.

AU - Alberts, Steven Robert

AU - Loprinzi, Charles Lawrence

AU - Sargent, Daniel J.

AU - Sargent, Daniel J.

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Y1 - 2014/12/1

N2 - Background Current prognostic tools in colon cancer use relatively few patient characteristics. We constructed and validated clinical calculators for overall survival (OS) and time to recurrence (TTR) for stage III colon cancer and compared their performance against an existing tool (Numeracy) and American Joint Committee on Cancer (AJCC) version 7 staging. Methods Data from 15936 stage III patients accrued to phase III clinical trials since 1989 were used to construct Cox models for TTR and OS. Variables included age, sex, race, body mass index, performance status, tumor grade, tumor stage, ratio of positive lymph nodes to nodes examined, number and location of primary tumors, and adjuvant treatment (fluoropyrimidine single agent or in combination). Missing data were imputed, and final models internally validated for optimism-corrected calibration and discrimination and compared with AJCC. External validation and comparisons against Numeracy were performed using stage III patients from NSABP trial C-08. All statistical tests were two-sided. Results All variables were statistically and clinically significant for OS prediction, while age and race did not predict TTR. No meaningful interactions existed. Models for OS and TTR were well calibrated and associated with C-indices of 0.66 and 0.65, respectively, compared with C-indices of 0.58 and 0.59 for AJCC. These tools, available online, better predicted patient outcomes than Numeracy, both overall and within patient subgroups, in external validation. Conclusions The proposed ACCENT calculators are internally and externally valid, better discriminate patient risk than AJCC version 7 staging, and better predict patient outcomes than Numeracy. These tools have replaced Numeracy for online clinical use and will aid prognostication and patient/physician communication.

AB - Background Current prognostic tools in colon cancer use relatively few patient characteristics. We constructed and validated clinical calculators for overall survival (OS) and time to recurrence (TTR) for stage III colon cancer and compared their performance against an existing tool (Numeracy) and American Joint Committee on Cancer (AJCC) version 7 staging. Methods Data from 15936 stage III patients accrued to phase III clinical trials since 1989 were used to construct Cox models for TTR and OS. Variables included age, sex, race, body mass index, performance status, tumor grade, tumor stage, ratio of positive lymph nodes to nodes examined, number and location of primary tumors, and adjuvant treatment (fluoropyrimidine single agent or in combination). Missing data were imputed, and final models internally validated for optimism-corrected calibration and discrimination and compared with AJCC. External validation and comparisons against Numeracy were performed using stage III patients from NSABP trial C-08. All statistical tests were two-sided. Results All variables were statistically and clinically significant for OS prediction, while age and race did not predict TTR. No meaningful interactions existed. Models for OS and TTR were well calibrated and associated with C-indices of 0.66 and 0.65, respectively, compared with C-indices of 0.58 and 0.59 for AJCC. These tools, available online, better predicted patient outcomes than Numeracy, both overall and within patient subgroups, in external validation. Conclusions The proposed ACCENT calculators are internally and externally valid, better discriminate patient risk than AJCC version 7 staging, and better predict patient outcomes than Numeracy. These tools have replaced Numeracy for online clinical use and will aid prognostication and patient/physician communication.

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