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Predicting Risk of Recurrence After Colorectal Cancer Surgery in the United States: An Analysis of a Special Commission on Cancer National Study

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several factors can affect the risk of recurrence after curative resection of colorectal cancer (CRC). We aimed to develop a risk model for recurrence after definitive treatment of Stage I–III CRC using data from a nationally representative database and to develop an individualized web-based risk calculator.

Methods

A random sample of patients who underwent resection for Stage I–III CRC between 2006 and 2007 at Commission on Cancer (CoC) accredited centers were included. Primary data regarding first recurrence was abstracted from medical records and merged with the National Cancer Database. Multivariable cox regression analysis was used to test for factors associated with cancer recurrence, stratified by stage. Model performance was tested by c statistic and calibration plots. Hazard Ratios were utilized to develop an individualized web-based recurrence prediction tool.

Results

A total of 8249 patients from 1175 CoC centers were included. Of these, 1656 (20.1%) patients had a recurrence during 5 years of follow-up. Median time to recurrence was 16 months. The final predictive models displayed excellent discrimination and calibration with concordance indexes of 0.7. The online calculator included 12 variables, including tumor site, stage, time since surgery, and surveillance intensity. Output is displayed numerically and graphically with an icon array.

Conclusions

Using primarily abstracted recurrence data from a random sample of patients treated for CRC at CoC accredited centers across the United States, we successfully created an individualized CRC recurrence risk assessment tool. This web-based calculator can be used by physicians and patients in shared decision making to guide management discussions.

Trial Registration

ClinicalTrials.gov Registration Number: NCT02217865.

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References

  1. NCI. Surveillance, Epidemiology, and End Results Program, Cancer Stat Facts: Colorectal Cancer. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed 26 Apr 2019.

  2. Kawai K, Nozawa H, Hata K, et al. Nomogram predicting survival after recurrence in patients with stage I to III colon cancer: a nationwide multicenter study. Dis Colon Rectum. 2018;61(9):1053–62.

    Article  Google Scholar 

  3. Liska D, Stocchi L, Karagkounis G, et al. Incidence, patterns, and predictors of locoregional recurrence in colon cancer. Ann Surg Oncol. 2017;24(4):1093–9.

    Article  Google Scholar 

  4. Okamura R, Hida K, Nishizaki D, Sugihara K, Sakai Y. Proposal of a stage-specific surveillance strategy for colorectal cancer patients: a retrospective analysis of Japanese large cohort. Eur J Surg Oncol. 2018;44(4):449–55.

    Article  Google Scholar 

  5. Osterman E, Glimelius B. Recurrence risk after up-to-date colon cancer staging, surgery, and pathology: analysis of the entire Swedish population. Dis Colon Rectum. 2018;61(9):1016–25.

    Article  Google Scholar 

  6. Rose J, Augestad KM, Cooper GS. Colorectal cancer surveillance: what’s new and what’s next. World J Gastroenterol. 2014;20(8):1887–97.

    Article  Google Scholar 

  7. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg. 2010;97(11):1638–45.

    Article  CAS  Google Scholar 

  8. Weiser MR, Landmann RG, Kattan MW, et al. Individualized prediction of colon cancer recurrence using a nomogram. J Clin Oncol. 2008;26(3):380–5.

    Article  Google Scholar 

  9. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ Can Med Assoc J. 1995;152(9):1423–33.

    CAS  Google Scholar 

  10. Nielsen-Bohlman L, Panzer AM. Health literacy: a prescription to end confusion. Washington, DC: Institute of Medicine/National Academies Press; 2004.

    Google Scholar 

  11. National Cancer Database. Available at: https://www.facs.org/quality-programs/cancer/ncdb/about. Accessed 21 Jan 2019.

  12. Snyder RA, Hu CY, Cuddy A, et al. Association between intensity of posttreatment surveillance testing and detection of recurrence in patients with colorectal cancer. JAMA. 2018;319(20):2104–15.

    Article  Google Scholar 

  13. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual, 7th ed. New York: Springer; 2010.

    Google Scholar 

  14. NCDB. Participant User File, Data Dictionary. Available at: https://www.facs.org/quality-programs/cancer/ncdb/puf. Accessed 21 Jan 2019.

  15. Satagopan JM, Ben-Porat L, Berwick M, Robson M, Kutler D, Auerbach AD. A note on competing risks in survival data analysis. Br J Cancer. 2004;91(7):1229–35.

    Article  CAS  Google Scholar 

  16. Cox D, Reid N. Analysis of survival data. New York: Routledge; 1984.

    Google Scholar 

  17. Zhang MJ. Cox proportional hazards regression models for survival data in cancer research. Cancer Treat Res. 2002;113:59–70.

    Article  Google Scholar 

  18. Lee YT. Local and regional recurrence of carcinoma of the colon and rectum: I. Tumour-host factors and adjuvant therapy. Surg Oncol. 1995;4(6):283–93.

  19. Lee YT. Local and regional recurrence of carcinoma of the colon and rectum: II. Factors relating to operative technique. Surg Oncol. 1996;5(1):1–13.

  20. Elferink MA, Visser O, Wiggers T, et al. Prognostic factors for locoregional recurrences in colon cancer. Ann Surg Oncol. 2012;19(7):2203–11.

    Article  CAS  Google Scholar 

  21. Stocchi L, Nelson H, Sargent DJ, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol. 2001;19(18):3895–902.

    Article  CAS  Google Scholar 

  22. Berian JR, Cuddy A, Francescatti AB, et al. A systematic review of patient perspectives on surveillance after colorectal cancer treatment. J Cancer Survivorship Res Pract. 2017;11(5):542–52.

    Article  Google Scholar 

  23. Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor’s perspective. J Clin Oncol. 2011;29(10):1280–9.

    Article  Google Scholar 

  24. Kattan MW, Zelefsky MJ, Kupelian PA, et al. Pretreatment nomogram that predicts 5-year probability of metastasis following three-dimensional conformal radiation therapy for localized prostate cancer. J Clin Oncol. 2003;21(24):4568–71.

    Article  Google Scholar 

  25. Hung YT, Wu CF, Liang TH, et al. Developing a decision-aid website for breast cancer surgery: an action research approach. J Med Internet Res. 2019;21(2):e10404.

    Article  Google Scholar 

  26. Gornick MC, Kurian AW, An LC, et al. Knowledge regarding and patterns of genetic testing in patients newly diagnosed with breast cancer participating in the iCanDecide trial. Cancer. 2018;124(20):4000–9.

    Article  CAS  Google Scholar 

  27. Volk RJ, Linder SK, Leal VB, et al. Feasibility of a patient decision aid about lung cancer screening with low-dose computed tomography. Prevent Med. 2014;62:60–3.

    Article  Google Scholar 

  28. Lowenstein LM, Deyter GMR, Nishi S, Wang T, Volk RJ. Shared decision-making conversations and smoking cessation interventions: critical components of low-dose CT lung cancer screening programs. Transl lung Cancer Res. 2018;7(3):254–71.

    Article  Google Scholar 

  29. Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317(13):1309–10.

    Article  Google Scholar 

  30. Stacey D, Legare F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Systematic Rev. 2017;4:CD001431.

  31. Volk RJ, Linder SK, Lopez-Olivo MA, et al. Patient decision aids for colorectal cancer screening: a systematic review and meta-analysis. Am J Prevent Med. 2016;51(5):779–91.

    Article  Google Scholar 

  32. Honda M, Oba K, Akiyoshi T, et al. Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials. Oncotarget. 2017;8(58):99150–60.

    Article  Google Scholar 

  33. Peng J, Ding Y, Tu S, et al. Prognostic nomograms for predicting survival and distant metastases in locally advanced rectal cancers. PloS One. 2014;9(8):e106344.

    Article  Google Scholar 

  34. Valentini V, van Stiphout RG, Lammering G, et al. Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol. 2011;29(23):3163–72.

    Article  Google Scholar 

  35. Kawai K, Sunami E, Yamaguchi H, et al. Nomograms for colorectal cancer: a systematic review. World J Gastroenterol. 2015;21(41):11877–86.

    Article  CAS  Google Scholar 

  36. Andre T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350(23):2343–51.

    Article  CAS  Google Scholar 

Download references

Funding

This research was supported by a PCORI award – Award Number CE1304-6855 (GJC) and in part by the Assessment, Intervention and Measurement (AIM) Shared Resource through a Cancer Center Support Grant (CA16672, MD Anderson Cancer Center), from the National Cancer Institute, National Institutes of Health, and the Duncan Family Institute for Cancer Prevention and Risk Assessment.

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Authors and Affiliations

  1. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Syed Nabeel Zafar MBBS, MPH, Chung-Yuan Hu MPH, PhD, Rebecca A. Snyder MD, MPH, Amanda Cuddy MPH, Y. Nancy You MD, MHSc & George J. Chang MD, MS

  2. Departments of Surgery and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA

    Rebecca A. Snyder MD, MPH

  3. Medpace, Houston, TX, USA

    Amanda Cuddy MPH

  4. Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA

    Lisa M. Lowenstein PhD, Robert J. Volk PhD & George J. Chang MD, MS

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  1. Syed Nabeel Zafar MBBS, MPH
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  2. Chung-Yuan Hu MPH, PhD
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  3. Rebecca A. Snyder MD, MPH
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  8. George J. Chang MD, MS
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Correspondence to George J. Chang MD, MS.

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Zafar, S.N., Hu, CY., Snyder, R.A. et al. Predicting Risk of Recurrence After Colorectal Cancer Surgery in the United States: An Analysis of a Special Commission on Cancer National Study. Ann Surg Oncol 27, 2740–2749 (2020). https://doi.org/10.1245/s10434-020-08238-7

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  • DOI: https://doi.org/10.1245/s10434-020-08238-7

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