Identifying Recurrences Among Non-Metastatic Colorectal Cancer Patients Using National Health Data Registries: Validation and Optimization of a Registry-Based Algorithm in a Modern Danish Cohort

Nors, Jesper; Mattesen, Trine B.; Cronin-Fenton, Deirdre; Mailhac, Aurélie; Bramsen, Jesper B.; Gotschalck, Kåre Andersson; Erichsen, Rune; Andersen, Claus L.

doi:10.2147/clep.s396140

Cited by 3 publications

(10 citation statements)

References 34 publications

(51 reference statements)

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“…Recurrence was detected using a previously described algorithm, with a few optimizations (eFigure 2 in Supplement 1). The algorithm defines recurrence when at least 1 of the following 4 indicators occurs:…”

Section: Methodsmentioning

confidence: 99%

“…uniform registration using the Danish version of the Systematized Nomenclature of Medicine (SNOMED) codes. 29 Recurrence was detected using a previously described algorithm, 30…”

Section: Key Pointsmentioning

confidence: 99%

“…Furthermore, we recently validated the algorithm we used and found that it was highly accurate (sensitivity, 94%; specificity, 99%; positive predictive value, 94%; and negative predictive value, 99%) when using contemporary registry data, 31 which is in line with previous validations on historical cohorts. 30 Also, the registry data needed for the algorithm is available for the entire cohort, as all Danish citizens have unrestricted access to a public taxsupported health care system. 50 It can be considered a limitation that we excluded approximately 15% of patients, particularly patients with previous cancers, as the algorithm cannot discern whether recurrence occurs due to one or the other cancer.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Incidence of Recurrence and Time to Recurrence in Stage I to III Colorectal Cancer

Nors,

Iversen,

Erichsen

et al. 2024

JAMA Oncol

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ImportanceManagement of colorectal cancer (CRC) has been updated continuously over the past 2 decades. While the combination of these initiatives has had implications for improved survival, the implications for rates of recurrence remain unexplored.ObjectiveTo ascertain the rates of recurrence and describe time to recurrence within 5 years of surgery with curative intent for stages I to III CRC.Design, Setting, and ParticipantsThis cohort study used the Danish Colorectal Cancer Group Database to identify patients with Union for International Cancer Control (UICC) stages I to III CRC who underwent primary surgery between January 1, 2004, and December 31, 2019. They were followed up until recurrence (event), death (competing event), diagnosis of a second cancer (competing event), emigration (censoring event), 5 years postoperatively (censoring event), or January 1, 2023 (censoring event), whichever came first. Recurrence status was ascertained through individual-level linked data from the Danish Cancer Registry, Danish National Patient Registry, and Danish Pathology Registry using a validated algorithm. Data were analyzed from January 1 to August 8, 2023.ExposurePrimary surgery performed during 3 calendar periods (2004-2008, 2009-2013, and 2014-2019) stratified by tumor site (colon or rectum) and UICC stage (I, II, and III).Main Outcomes and MeasuresStage-specific 5-year recurrence reported as the cumulative incidence function (CIF) of recurrence, the association between calendar period of primary surgery and recurrence risk reported as subdistribution hazard ratios (sHRs), and the time from surgery to recurrence.ResultsOf the 34 166 patients with UICC stages I to III CRC (median [IQR] age, 70 [62-77] years); 18 552 males [54.3%]) included in the study, 7027 developed recurrence within 5 years after the primary surgery. For colon cancer, the 5-year CIF of recurrence decreased over the 3 calendar periods from 16.3% to 6.8% for UICC stage I, from 21.9% to 11.6% for UICC stage II, and from 35.3% to 24.6% for UICC stage III colon cancer. For rectal cancer, the 5-year CIF decreased over the 3 periods from 19.9% to 9.5% for stage I, from 25.8% to 18.4% for stage II, and from 38.7% to 28.8% for stage III disease. Patients with stage III disease had a shorter time from surgery to recurrence compared with those with stage I disease (time ratio stage III vs stage I = 0.30; 95% CI, 0.28-0.32). Cancers detected through screening were associated with lower stage-adjusted risks of recurrence (sHR, 0.81; 95% CI, 0.73-0.91) compared with cancers not detected through screening.Conclusions and RelevanceIn this cohort of patients with CRC, the risk of recurrence decreased in patients with stages I to III disease during the study period. Cancer detection by screening was associated with an even lower risk of recurrence. Time to recurrence differed according to UICC stage. Because the risk of recurrence was so low in selected patient groups, future research is warranted to explore risk-stratified surveillance protocols in patients with CRC.

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Section: Methodsmentioning

confidence: 99%

“…uniform registration using the Danish version of the Systematized Nomenclature of Medicine (SNOMED) codes. 29 Recurrence was detected using a previously described algorithm, 30…”

Section: Key Pointsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of Recurrence and Time to Recurrence in Stage I to III Colorectal Cancer

Nors,

Iversen,

Erichsen

et al. 2024

JAMA Oncol

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“…Recurrence status was determined using a validated algorithm previously described in detail. 20,21 The algorithm defined recurrence as at least one of the following four indicators: The date of recurrence was defined as the earliest date on which at least one of the four indicators of the algorithm were met, and all other codes meeting an indication within the following 60 days were classified as belonging to the same recurrence event, acknowledging that there is some delay in getting the diagnostic workup of the recurrence registered in the national registries.…”

Section: Data Sources and Identification Of Recurrencementioning

confidence: 99%

Incidence of late recurrence and second primary cancers 5–10 years after non‐metastatic colorectal cancer

Nors,

Gotschalck,

Erichsen

et al. 2024

Intl Journal of Cancer

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The fraction of patients who are cancer‐free survivors 5 years after curative‐intended surgery for colorectal cancer (CRC) is increasing, suggesting that extending surveillance beyond 5 years may be indicated. Here we estimate the incidence of late recurrence, metachronous CRC, and second primary cancers 5–10 years postoperative. All patients resected for UICC stage I–III CRC in Denmark through 2004–2013 were identified. Through individual‐level linkage of nationwide health registry data, recurrence status was determined using a validated algorithm. Cancer‐free survivors 5 years after surgery, were included. Cumulative incidence functions (CIF) of late recurrence, metachronous CRC, and second primary cancer 5–10 years postoperative were constructed. Subdistribution hazards ratios (sHR) were computed using Fine‐Gray regression. Among 8883 patients, 370 developed late recurrence (5–10‐year CIF = 4.1%, 95%CI: 3.7%–4.6%), 270 metachronous CRC (5–10‐year CIF = 3.0%, 95%CI: 2.7%–3.4%), and 635 a second primary cancer (5–10‐year CIF = 7.2%, 95%CI: 6.7%–7.7%). The risk of late recurrence was reduced for patients operated in 2009–2013 compared to 2004–2008 (2.9% vs. 5.6%, sHR = 0.52, 95% CI: 0.42–0.65). The risk of metachronous CRC was likewise reduced from 4.1% to 2.1% (sHR = 0.50, 95%CI: 0.39–0.65). While the risk of second primary cancer did not change between 2009–2013 and 2004–2008 (7.1% vs. 7.1%, sHR = 0.98, 95% CI: 0.84–1.15). Using nation‐wide 10‐year follow‐up data, we document that the incidences of late recurrence and metachronous CRC are low and decreasing from 2004 to 2013. Thus, despite increasing numbers of long‐term cancer survivors, the data do not advocate for extending CRC‐specific surveillance beyond 5 years.

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“…Audit and publications looking at the quality of MR scans and assessment of the quality of surgery correlating pathology, MR and CT scans culminated in several publications [4]. This has resulted in a substantial improvement in outcome and the survival in Denmark is superior to the other Scandinavian countries with the largest improvement in oncological outcomes compared with five other high-income countries, over a 15-year period [5,6].…”

mentioning

confidence: 99%

Specialization improves rectal cancer management: humans not machines determine optimal outcome

Moran,

Laurberg

2024

Colorectal Disease

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Identifying Recurrences Among Non-Metastatic Colorectal Cancer Patients Using National Health Data Registries: Validation and Optimization of a Registry-Based Algorithm in a Modern Danish Cohort

Cited by 3 publications

References 34 publications

Incidence of Recurrence and Time to Recurrence in Stage I to III Colorectal Cancer

Incidence of Recurrence and Time to Recurrence in Stage I to III Colorectal Cancer

Incidence of late recurrence and second primary cancers 5–10 years after non‐metastatic colorectal cancer

Specialization improves rectal cancer management: humans not machines determine optimal outcome

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