L A Renfro1, A Grothey2, D Kerr3, D G Haller4, T André5, E Van Cutsem6, L Saltz7, R Labianca8, C L Loprinzi2, S R Alberts2, H Schmoll9, C Twelves10, G Yothers11, D J Sargent12. 1. Division of Biomedical Statistics and Informatics. Electronic address: renfro.lindsay@mayo.edu. 2. Department of Oncology, Mayo Clinic, Rochester, USA. 3. Radcliffe Department of Medicine, University of Oxford, Oxford, UK. 4. School of Medicine, University of Pennsylvania, Philadelphia, USA. 5. Hôpital Saint Antoine, Paris; Pierre and Marie Curie University, Paris, France. 6. Digestive Oncology Unit, University Hospital Gasthuisberg/Leuven, Leuven, Belgium. 7. Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, USA. 8. Oncology Unit, Ospedale Giovanni XXIII, Bergamo, Italy. 9. Department for Internal Medicine IV, University Clinic Halle, Halle, Germany. 10. Leeds Institute of Cancer and Pathology, University of Leeds and St James's University Hospital, Leeds Cancer Research UK Centre, Leeds, UK. 11. National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Pittsburgh, USA. 12. Division of Biomedical Statistics and Informatics.
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.
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.
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