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

Abstract

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.

Lead Time and Prognostic Role of Serum CEA, CA19-9, IL-6, CRP, and YKL-40 after Adjuvant Chemotherapy in Colorectal Cancer

“…Several studies have investigated whether intensified follow-up or addition of other surveillance methods along with CEA could offer a survival benefit by advancing the diagnosis of metastatic disease and thus enabling metastasectomy [14,15]. To date, no survival benefit has been noted in retrospective studies [49,50], prospective studies [13], meta-analyses [14,15], or randomised trials [47,51]. In our study, prospective CEA and CA19-9 measurements were combined with yearly radiology impacting biomarker results.…”

Evaluation of Recurrence Risk After Curative Resection for Patients With Stage I to III Colorectal Cancer Using the Hazard Function

“…According to a 2007 Cochrane analysis report, short-interval surveillance for patients with CRC after curative surgery improved OS due to early detection of asymptomatic recurrences and curative-intent surgical resection 1,3,24 . In contrast, an updated 2016 Cochrane analysis, 25 which included additional clinical trials, 26–30 found no improvement in OS by intensifying the surveillance of patients after curative surgery. However, the surveillance schedules between the 2 reports differed and this may be the reason why short-interval surveillance did not result in a consistent improvement in OS.…”

Surveillance Strategies in Endometrial Cancer Care: Why Less Represents Progress

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