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

doi:10.1245/s10434-020-08238-7

. 2020 Aug;27(8):2740-2749.

doi: 10.1245/s10434-020-08238-7. Epub 2020 Feb 20.

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

Syed Nabeel Zafar¹, Chung-Yuan Hu¹, Rebecca A Snyder^{1

2}, Amanda Cuddy^{1

3}, Y Nancy You¹, Lisa M Lowenstein⁴, Robert J Volk⁴, George J Chang^{5

6}

Affiliations

¹ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
² Departments of Surgery and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
³ Medpace, Houston, TX, USA.
⁴ Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA.
⁵ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA. gchang@mdanderson.org.
⁶ Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA. gchang@mdanderson.org.

PMID: 32080809
DOI: 10.1245/s10434-020-08238-7

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

Syed Nabeel Zafar et al. Ann Surg Oncol. 2020 Aug.

. 2020 Aug;27(8):2740-2749.

doi: 10.1245/s10434-020-08238-7. Epub 2020 Feb 20.

Authors

Syed Nabeel Zafar¹, Chung-Yuan Hu¹, Rebecca A Snyder^{1

2}, Amanda Cuddy^{1

3}, Y Nancy You¹, Lisa M Lowenstein⁴, Robert J Volk⁴, George J Chang^{5

6}

Affiliations

¹ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
² Departments of Surgery and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
³ Medpace, Houston, TX, USA.
⁴ Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA.
⁵ Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA. gchang@mdanderson.org.
⁶ Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA. gchang@mdanderson.org.

PMID: 32080809
DOI: 10.1245/s10434-020-08238-7

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.
1. 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. - DOI
1. 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. - DOI
1. 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. - DOI
1. 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. - DOI

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

[3] 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. - DOI

[4] 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. - DOI

[5] 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. - DOI

[6] 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. - DOI

[7] 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. - DOI

[8] 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. - DOI

[9] 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. - DOI

[10] 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. - DOI

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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

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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

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