Comparison of outcomes after fluorouracil-based adjuvant therapy for stages II and III colon cancer between 1978 to 1995 and 1996 to 2007: evidence of stage migration from the ACCENT database.

Qian D Shi, Thierry Andre, Axel F Grothey, Greg Yothers, Stanley R. Hamilton, Brian M. Bot, Daniel G. Haller, Eric Van Cutsem, Chris Twelves, Jacqueline K. Benedetti, Michael J. O'Connell, Daniel J. Sargent

Research output: Contribution to journalArticle

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Abstract

With improved patient care, better diagnosis, and more treatment options after tumor recurrence, outcomes after fluorouracil (FU) -based treatment are expected to have improved over time in early-stage colon cancer. Data from 18,449 patients enrolled onto 21 phase III trials conducted from 1978 to 2002 were evaluated for potential differences in time to recurrence (TTR), time from recurrence to death (TRD), and overall survival (OS) with regard to FU-based adjuvant regimens. Trials were predefined as old versus newer era using initial accrual before or after 1995. Outcomes were compared between patients enrolled onto old- or newer-era trials, stratified by stage. Within the first 3 years, recurrence rates were lower in newer- versus old-era trials for patients with stage II disease, with no differences among those with stage III disease. Both TRD and OS were significantly longer in newer-era trials overall and within each stage. The lymph node (LN) ratio (ie, number of positive nodes divided by total nodes harvested) in those with stage III disease declined over time. TTR improved slightly, with larger number of LNs examined in both stages. Improved TRD in newer trials supports the premise that more aggressive intervention (oxaliplatin- and irinotecan-based chemotherapy and/or surgery for recurrent disease) improves OS for patients previously treated in the adjuvant setting. Lower recurrence rates with identical treatments in those with stage II disease enrolled onto newer-era trials reflect stage migration over time, calling into question historical data related to the benefit of FU-based adjuvant therapy in such patients.

Original languageEnglish (US)
Pages (from-to)3656-3663
Number of pages8
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume31
Issue number29
StatePublished - Oct 10 2013

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Fluorouracil
Colonic Neoplasms
Databases
Recurrence
irinotecan
oxaliplatin
Survival
Therapeutics
Patient Care
Lymph Nodes
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

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Comparison of outcomes after fluorouracil-based adjuvant therapy for stages II and III colon cancer between 1978 to 1995 and 1996 to 2007 : evidence of stage migration from the ACCENT database. / Shi, Qian D; Andre, Thierry; Grothey, Axel F; Yothers, Greg; Hamilton, Stanley R.; Bot, Brian M.; Haller, Daniel G.; Van Cutsem, Eric; Twelves, Chris; Benedetti, Jacqueline K.; O'Connell, Michael J.; Sargent, Daniel J.

In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Vol. 31, No. 29, 10.10.2013, p. 3656-3663.

Research output: Contribution to journalArticle

Shi, Qian D ; Andre, Thierry ; Grothey, Axel F ; Yothers, Greg ; Hamilton, Stanley R. ; Bot, Brian M. ; Haller, Daniel G. ; Van Cutsem, Eric ; Twelves, Chris ; Benedetti, Jacqueline K. ; O'Connell, Michael J. ; Sargent, Daniel J. / Comparison of outcomes after fluorouracil-based adjuvant therapy for stages II and III colon cancer between 1978 to 1995 and 1996 to 2007 : evidence of stage migration from the ACCENT database. In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2013 ; Vol. 31, No. 29. pp. 3656-3663.
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