Post-treatment surveillance testing of patients with colorectal cancer and the association with survival: protocol for a retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database

Hines, Rebecca; Jiban, Jibanul Haque; Choudhury, Kanak; Loerzel, Victoria; Specogna, Adrian V.; Troy, Steven P; Zhang, Shunpu

doi:10.1136/bmjopen-2018-022393

Cited by 9 publications

(14 citation statements)

References 39 publications

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“…Earlier RCTs on this topic were hampered by a number of limitations which resulted in conflicting evidence [15, 17]. Recently, higher quality studies have provided a more consistent conclusion regarding more vs. less surveillance testing.…”

Section: Discussionmentioning

confidence: 99%

“…Study methodology has been described although some differences will be presented herein [17]. The study population consisted of colon cancer patients, 66–84 years of age, who were diagnosed between 2002 to 2009 and included in the NCI’s SEER-Medicare database.…”

Section: Methodsmentioning

confidence: 99%

“…For the assessment of yearly and overall surveillance, we modified our original strategy in order to capture the totality of the surveillance experience [17]. For CEA, which requires a minimum of two tests per year to meet minimum guidelines, we classified each year of follow-up according to the number of CEA tests as ≥2, 1, or 0.…”

Section: Methodsmentioning

confidence: 99%

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The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

et al. 2019

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Background The best strategy for surveillance testing in stage II and III colon cancer patients following curative treatment is unknown. Previous randomized controlled trials have suffered from design limitations and yielded conflicting evidence. This observational comparative effectiveness research study was conducted to provide new evidence on the relationship between post-treatment surveillance testing and survival by overcoming the limitations of previous clinical trials. Methods This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims (SEER-Medicare). Stage II and III colon cancer patients diagnosed from 2002 to 2009 and between 66 to 84 years of age were eligible. Adherence to surveillance testing guidelines—including carcinoembryonic antigen, computed tomography, and colonoscopy—was assessed for each year of follow-up and overall for up to three years post-treatment. Patients were categorized as More Adherent and Less Adherent according to testing guidelines. Patients who received no surveillance testing were excluded. The primary outcome was 5-year cancer-specific survival; 5-year overall survival was the secondary outcome. Inverse probability of treatment weighting (IPTW) using generalized boosted models was employed to balance covariates between the two surveillance groups. IPTW-adjusted survival curves comparing the two groups were performed by the Kaplan-Meier method. Weighted Cox regression was used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for the relative risk of death for the Less Adherent group versus the More Adherent group. Results There were 17,860 stage II and III colon cancer cases available for analysis. Compared to More Adherent patients, Less Adherent patients experienced slightly better 5-year cancer-specific survival (HR = 0.83, 95% CI 0.76–0.90) and worse 5-year noncancer-specific survival (HR = 1.61, 95% CI 1.43–1.82) for years 2 to 5 of follow-up. There was no difference between the groups in overall survival (HR = 1.04, 95% CI 0.98–1.10). Conclusions More surveillance testing did not improve 5-year cancer-specific survival compared to less testing and there was no difference between the groups in overall survival. The results of this study support a risk-stratified, shared decision-making surveillance strategy to optimize clinical and patient-centered outcomes for colon cancer patients in the survivorship phase of care. Electronic supplementary material The online version of this article (10.1186/s12885-019-5613-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

et al. 2019

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“…Although an ever-expanding armamentarium of systemic therapy has improved the prognosis of stage IV CRC, with 5-year survival approaching 20%, most cases of CRC recurring after definitive treatment of early-stage disease are incurable (4). The primary motivation for aggressive surveillance after treatment of early-stage CRC is therefore the detection of limited metastatic disease amenable to potentially curative surgical resection (5,6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Circulating Tumor DNA for Methylated BCAT1 and IKZF1 to Detect Recurrence of Stage II/Stage III Colorectal Cancer (CRC)

Musher

Melson

Amato

et al. 2020

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Most recurrences of early-stage colorectal cancer (CRC) detected with current surveillance measures are widespread and incurable. Circulating tumor DNA (ctDNA) may facilitate earlier diagnosis of recurrent CRC and improve cancer-related outcomes. Methods: Plasma from patients undergoing standard surveillance after definitive treatment for stage II/III CRC was assayed with COLVERA and carcinoembryonic antigen (CEA) at a single time-point. Results were correlated with radiographic imaging. Assay performance, including sensitivity and specificity for recurrence, were compared. Impact of potentially confounding variables was also explored. Results: 322 patients were included in the final analysis, and 27 recurrences were documented over a median follow-up period of 15 months. Sensitivity for recurrence was 63% (CI 42.4-80.6) and 48% (CI 28.7-68.1) for COLVERA and CEA (≥5ng/mL), respectively (p=0.046), while specificity was 91.5% (CI 87.7-94.4) and 96.3% (CI 93.4-98.1), respectively (p=0.016). Smoking and age were independent predictors of CEA but not COLVERA positivity. Conclusion: COLVERA was more sensitive but less specific than CEA in detecting recurrent CRC. Short median follow-up may have been responsible for apparent false positives in COLVERA. Studies with serial sampling and longer follow-up are needed to assess whether earlier detection of CRC recurrence translates into clinical benefit. Impact: This prospective study showed that COLVERA (a two-gene ctDNA assay) was more sensitive for detection of recurrence in a cohort of patients undergoing surveillance after definitive therapy for stages II and III CRC Association for Cancer Research.

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“…Even with advanced treatment with a combined approach of routine therapy and molecular targeting treatment, the median survival time was not significantly improved. 3 Still, >50% of patients develop metastasis and recurrence after surgery. 4 , 5 Therefore, early diagnosis and therapy hold a significant prognostic value.…”

Section: Introductionmentioning

confidence: 99%

High expression of TFEB is associated with aggressive clinical features in colorectal cancer

Liang¹,

Jia²,

Wang³

et al. 2018

OTT

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ObjectivesThe transcription factor EB (TFEB), a member of the micropthalmia family, has been found to be associated with autophagy and upregulated in some kinds of tumors. However, very few studies focused on TFEB in colorectal cancer (CRC). TFEB expression status and its relevance to clinical features in CRC would be analyzed in this study.Materials and methodsReal-time PCR, Western blot, and immunohistological staining were used to evaluate TFEB expression in CRC tissues and adjacent normal tissues, and the role of TFEB in CRC cell lines was investigated in vitro and in vivo.ResultsTFEB was expressed at lower level in CRC tissues than normal in both mRNA and protein level. However, there were significantly positive correlations between TFEB expression in cancer tissues and malignant progression of CRC. Cancers with TFEB overexpression always had deeper infiltration and higher lymphatic metastasis rate. Furthermore, patients with high TFEB levels always had poor survival, and higher TFEB expression could be a predictor of survival in multivariate analysis. Meanwhile, knockdown TFEB by shRNA or knockout TFEB by sgRNA in CRC cell lines could significantly inhibit cell proliferation and migration in amino acid-free medium. In addition, we found a positive relationship between TFEB and Beclin1 expression, and silencing TFEB inhibited Beclin1 expression in CRC cells.ConclusionTFEB expression correlated with aggressive clinical features in CRC, and higher TFEB expression could be a prognostic factor and potential treatment target of CRC.

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Post-treatment surveillance testing of patients with colorectal cancer and the association with survival: protocol for a retrospective cohort study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database

Cited by 9 publications

References 39 publications

The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

Evaluation of Circulating Tumor DNA for Methylated BCAT1 and IKZF1 to Detect Recurrence of Stage II/Stage III Colorectal Cancer (CRC)

High expression of TFEB is associated with aggressive clinical features in colorectal cancer

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