A new prognostic and predictive tool for shared decision making in stage III colon cancer.
Antimetabolites, Antineoplastic
/ administration & dosage
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Chemotherapy, Adjuvant
Clinical Decision-Making
Colectomy
/ adverse effects
Colonic Neoplasms
/ mortality
Databases, Factual
Decision Making, Shared
Decision Support Techniques
Disease-Free Survival
Humans
Neoplasm Staging
Oxaliplatin
/ administration & dosage
Patient Participation
Predictive Value of Tests
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Time Factors
Adjuvant
Colon cancer
Shared decision making
Stage III
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
02
04
2020
revised:
13
07
2020
accepted:
28
07
2020
pubmed:
7
9
2020
medline:
26
1
2021
entrez:
6
9
2020
Statut:
ppublish
Résumé
Survival of patients with stage III colon cancer varies widely according to T-N sub-stages. Estimating the benefit of each therapeutic option in each T-N subgroup may provide more accurate information helping doctors and patients in the complex shared decision-making process surrounding adjuvant therapy. The outcomes data of 12,834 patients with stage III colon cancer enrolled in the IDEA trial served as our database. Patients were categorised in 16 sub-stages, based on T-N categories. We created a meta-regression model to predict the expected 5-year DFS within each T-N sub-stage. We then evaluated the efficacy of each therapeutic option in every sub-stage, working backward by subtraction, using an average of the HRs reported in pertinent trial publications as a conversion factor. Large differences in 5-year DFS rate were observed among the subgroups, ranging from 89% (T1N1a) to 31% (T4N2b) in the overall population. The contribution to the outcome of each therapeutic option in this setting varied widely across sub-stages. According to our model, patients with T1N1a cancers have a projected 5-year DFS of 79.6% with surgery alone. Adjuvant fluoropyrimidine alone results in 5.6% absolute DFS gain; an additional 2.3% and 0.8% gain is seen with oxaliplatin for 3 and 6 months, respectively. Patients with T4N2b cancers show a 13.9% 5-year DFS with surgery alone, and an 11.2%, 6.4%, 2.5% increase with the aforementioned adjuvant options, respectively. The resulting overlay bar graph gives patients and doctors the projected relative benefit of each treatment option and may substantially help the shared decision-making process, although caution must be exercised in using this model due to the significant variance of the estimates.
Sections du résumé
BACKGROUND
Survival of patients with stage III colon cancer varies widely according to T-N sub-stages. Estimating the benefit of each therapeutic option in each T-N subgroup may provide more accurate information helping doctors and patients in the complex shared decision-making process surrounding adjuvant therapy.
METHODS
The outcomes data of 12,834 patients with stage III colon cancer enrolled in the IDEA trial served as our database. Patients were categorised in 16 sub-stages, based on T-N categories. We created a meta-regression model to predict the expected 5-year DFS within each T-N sub-stage. We then evaluated the efficacy of each therapeutic option in every sub-stage, working backward by subtraction, using an average of the HRs reported in pertinent trial publications as a conversion factor.
RESULTS
Large differences in 5-year DFS rate were observed among the subgroups, ranging from 89% (T1N1a) to 31% (T4N2b) in the overall population. The contribution to the outcome of each therapeutic option in this setting varied widely across sub-stages. According to our model, patients with T1N1a cancers have a projected 5-year DFS of 79.6% with surgery alone. Adjuvant fluoropyrimidine alone results in 5.6% absolute DFS gain; an additional 2.3% and 0.8% gain is seen with oxaliplatin for 3 and 6 months, respectively. Patients with T4N2b cancers show a 13.9% 5-year DFS with surgery alone, and an 11.2%, 6.4%, 2.5% increase with the aforementioned adjuvant options, respectively.
CONCLUSION
The resulting overlay bar graph gives patients and doctors the projected relative benefit of each treatment option and may substantially help the shared decision-making process, although caution must be exercised in using this model due to the significant variance of the estimates.
Identifiants
pubmed: 32892120
pii: S0959-8049(20)30431-7
doi: 10.1016/j.ejca.2020.07.031
pii:
doi:
Substances chimiques
Antimetabolites, Antineoplastic
0
Oxaliplatin
04ZR38536J
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
182-188Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest statement None to declare.