Surveillance Colonoscopy in Older Stage I Colon Cancer Patients and the Association With Colon Cancer-Specific Mortality

Abstract

OBJECTIVES: Guideline-issuing groups differ regarding the recommendation that patients with stage I colon cancer receive surveillance colonoscopy after cancer-directed surgery. This observational comparative effectiveness study was conducted to evaluate the association between surveillance colonoscopy and colon cancer-specific mortality in early stage patients. METHODS: This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Surveillance colonoscopy was assessed as a time-varying exposure up to 5 years after cancer-directed surgery with the following groups: no colonoscopy, one colonoscopy, and ≥ 2 colonoscopies. Inverse probability of treatment weighting was used to balance covariates. The time-dependent Cox regression model was used to obtain inverse probability of treatment weighting-adjusted hazard ratios (HRs), with 95% confidence intervals (CIs) for 5- and 10-year colon cancer, other cancer, and noncancer causes of death. RESULTS: There were 8,783 colon cancer cases available for analysis. Overall, compared with patients who received one colonoscopy, the no colonoscopy group experienced an increased rate of 10-year colon cancer-specific mortality (HR = 1.63; 95% CI 1.31–2.04) and noncancer death (HR = 1.36; 95% CI 1.25–1.49). Receipt of ≥ 2 colonoscopies was associated with a decreased rate of 10-year colon cancer-specific death (HR = 0.60; 95% CI 0.45–0.79), other cancer death (HR = 0.68; 95% CI 0.53–0.88), and noncancer death (HR = 0.69; 95% CI 0.62–0.76). Five-year cause-specific HRs were similar to 10-year estimates. DISCUSSION: These results support efforts to ensure that stage I patients undergo surveillance colonoscopy after cancer-directed surgery to facilitate early detection of new and recurrent neoplastic lesions.

Construction of a miRNA-mRNA Network Related to Exosomes in Colon Cancer

“…Although colon cancer conditions had a high prevalence, about 39% of new patients in the United States are diagnosed with localized lesions that can be operated on [ 7 ]. Therefore, how to detect and diagnose colon cancer early and accurately is an urgent problem to get a better prognosis and a longer survival time.…”

“…The mortality rate of colon cancer is affected by many factors, such as different countries, different dietary habits, and the timing of cancer screening programs [ 5 ], among which the disease stage is the major determinant. Therefore, it is especially important to detect paracancerous infiltration and related mechanisms early to reduce the risk of colon cancer metastasis [ 6 , 7 ].…”

Associations Between Patient Experience With Care, Race and Ethnicity, and Receipt of CRC Treatment Among SEER-CAHPS Patients With Multiple Comorbidities

“…Subsequently, adjuvant and surveillance procedures were identified in Medicare claims files using approaches outlined in previous work. [31][32][33][34] A summary of this approach is described in supplemental eTable 2.…”

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“…For the non-user, the value remains as 0 throughout the whole follow-up. This method accurately represented the exposure status without the need to exclude participants and has shown to reduce bias in other studies [2][3][4][5]. For example, estimates from a timedependent model provided estimates closest to the true treatment effect in a study to assess the effectiveness of postmastectomy radiation therapy in patients with cancer whilst controlling for variations in the timing of initiation of radiation therapy [6].…”