Development and validation of risk prediction equations to estimate survival in patients with colorectal cancer: cohort study

Abstract

Objective To develop and externally validate risk prediction equations to estimate absolute and conditional survival in patients with colorectal cancer. Design Cohort study. Setting General practices in England providing data for the QResearch database linked to the national cancer registry. Participants 44 145 patients aged 15-99 with colorectal cancer from 947 practices to derive the equations. The equations were validated in 15 214 patients with colorectal cancer from 305 different QResearch practices and 437 821 patients with colorectal cancer from the national cancer registry. Main outcome measures The primary outcome was all cause mortality and secondary outcome was colorectal cancer mortality. Methods Cause specific hazards models were used to predict risks of colorectal cancer mortality and other cause mortality accounting for competing risks, and these risk estimates were combined to obtain risks of all cause mortality. Separate equations were derived for men and women. Several variables were tested: age, ethnicity, deprivation score, cancer stage, cancer grade, surgery, chemotherapy, radiotherapy, smoking status, alcohol consumption, body mass index, family history of bowel cancer, anaemia, liver function test result, comorbidities, use of statins, use of aspirin, clinical values for anaemia, and platelet count. Measures of calibration and discrimination were determined in both validation cohorts at 1, 5, and 10 years. Results The final models included the following variables in men and women: age, deprivation score, cancer stage, cancer grade, smoking status, colorectal surgery, chemotherapy, family history of bowel cancer, raised platelet count, abnormal liver function, cardiovascular disease, diabetes, chronic renal disease, chronic obstructive pulmonary disease, prescribed aspirin at diagnosis, and prescribed statins at diagnosis. Improved survival in women was associated with younger age, earlier stage of cancer, well or moderately differentiated cancer grade, colorectal cancer surgery (adjusted hazard ratio 0.50), family history of bowel cancer (0.62), and prescriptions for statins (0.77) and aspirin (0.83) at diagnosis, with comparable results for men. The risk equations were well calibrated, with predicted risks closely matching observed risks. Discrimination was good in men and women in both validation cohorts. For example, the five year survival equations on the QResearch validation cohort explained 45.3% of the variation in time to colorectal cancer death for women, the D statistic was 1.86, and Harrell’s C statistic was 0.80 (both measures of discrimination, indicating that the scores are able to distinguish between people with different levels of risk). The corresponding results for all cause mortality were 42.6%, 1.77, and 0.79. Conclusions Risk prediction equations were developed and validated to estimate overall and conditional survival of patients with colorectal cancer accounting for an individual’s clinical and demographic characteristics. These equations can provide more individual...

Administration of adjuvant chemotherapy for stage II‐III colon cancer patients: An European population‐based study

“…Similar results were reported in a study from Ontario, Canada, while another study showed improved survival associated with ACT regardless of high‐risk features . Moreover, a recent large cohort study from England reported an increased risk of colorectal cancer death and no significant risk of death from other causes for Stage II patients receiving ACT . We observed ACT administration to be associated with higher survival in total Stage II patients in Sweden, and in high‐risk Stage II patients in all countries.…”

“…34 Moreover, a recent large cohort study from England reported an increased risk of colorectal cancer death and no significant risk of death from other causes for Stage II patients receiving ACT. 35 We observed ACT administration to be associated with higher survival in total Stage II patients in Sweden, and in high-risk Stage II patients in all countries. These patterns may support suggestions that the association of ACT with higher survival of high-risk Stage II patients seen in observational studies are primarily related to patient selection rather than reflect the direct benefit from ACT.…”

Colorectalis daganatokban a 2-es típusú cukorbetegség és a thrombocytosis előfordulása, a túlélésre gyakorolt hatásuk, a primer tumor műtéti eltávolítása előtt és után

“…Az egyéb okból bekövet-kező mortalitás eredménye alapján a szerzőkben felmerült a kérdés, hogy a betegek alacsonyabb túlélését a T2DM a tumoros betegséggel való kapcsolata miatt rontja-e, vagy valamilyen egyéb, a T2DM-mel kapcsolatos komorbiditás alakult-e ki a háttérben. Hippisley-Cox és munkacsoportja [50] a női és férfi CRC-betegeket kü-lön-külön vizsgálta abból a szempontból, hogy a T2DM milyen szerepet játszik a betegek túlélésében. Mindkét nem esetén rövidebb túlélési időket igazoltak T2DM jelenlétében (nők: esélyhányados: 1,12; 95%-os KI 1,02-1,23; férfiak: esélyhányados: 1,14; 95%-os KI 1,05-1,24), mint a nem T2DM-személyeknél.…”

“…Mindkét nem esetén rövidebb túlélési időket igazoltak T2DM jelenlétében (nők: esélyhányados: 1,12; 95%-os KI 1,02-1,23; férfiak: esélyhányados: 1,14; 95%-os KI 1,05-1,24), mint a nem T2DM-személyeknél. Li [49], illetve Hippisley-Cox [50] munkacsoportjának eredményét, a T2DM-et mint önálló, a túlélést befolyásoló tényezőt saját vizsgálati csoportunkban nem tudtuk alátámasztani, de ez a minta méretével is összefüggésben lehet.…”

Type 2 diabetes and colorectal cancer survival: The multiethnic cohort

“…16 Many predictors of survival among CRC patients have been identified; these may assist patients and healthcare personnel in decision making and disease management. 12 However, few previous studies have looked at the influence of T2D status in different ethnic groups. Given the high T2D incidence in many non-white populations 17 and the elevated CRC incidence in Japanese and African Americans 18 , it is of interest to identify ethnic-specific differences in the association to understand differences in prognosis.…”