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 language | English (US) |
|---|---|
| Article number | mdv073 |
| Pages (from-to) | 950-958 |
| Number of pages | 9 |
| Journal | Annals of Oncology |
| Volume | 26 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2015 |
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Keywords
- Early-stage colon cancer
- Individual patient data
- Long-term survival
- Meta-analysis
- Oxaliplatin chemotherapy
- Population
ASJC Scopus subject areas
- Oncology
- Hematology
Cite this
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; Sargent, D. J.
In: Annals of Oncology, Vol. 26, No. 5, mdv073, 01.05.2015, p. 950-958.Research output: Contribution to journal › Article
}
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, Axel F
AU - Kerr, D.
AU - Haller, D. G.
AU - André, T.
AU - Van Cutsem, E.
AU - Saltz, L.
AU - Labianca, R.
AU - Loprinzi, Charles Lawrence
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, Steven Robert
AU - Shi, Qian D
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 - Labianca, R.
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, A.
AU - Twelves, C.
AU - Sirzen, F.
AU - Cisar, L.
AU - Cutsem, E. Van
AU - Saltz, L.
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
M1 - mdv073
ER -