TY - JOUR
T1 - Recurrence and Postoperative Death in Patients with Colorectal Cancer
T2 - A New Perspective via Semi-competing Risk Framework
AU - Safari, Malihe
AU - Mahmoudi, Leila
AU - Baker, Emma K.
AU - Roshanaei, Ghodratollah
AU - Fallah, Ramazan
AU - Shahnavaz, Ali
AU - Asghari-Jafarabadi, Mohammad
N1 - Funding Information:
The authors would like to acknowledge and thank their collaboration with the Department of Biostatistics and Epidemiology, Zanjan University of Medical Sciences Faculty of Medicine, for providing the environment for modeling data and manuscript writing.
Publisher Copyright:
Copyright © Author(s)
PY - 2023/7
Y1 - 2023/7
N2 - Background/Aims: Cancer studies suffer from an overestimation of prediction of survival when both recurrence and death are of interest. This longitudinal study aimed to mitigate this problem utilizing a semi-competing risk approach evaluating the factors affecting recurrence and postoperative death in patients with colorectal cancer. Materials and Methods: This longitudinal prospective study was conducted in 284 patients with resected colorectal cancer who were referred to the Imam Khomeini Clinic in Hamadan, Iran, during 2001-2017. Primary outcomes were postoperative outcomes and patient survival, including time to recurrence (of colorectal cancer), time to death, and time to death after recurrence. All patients who were alive at the end of the study were censored for death and who did not experience recurrence of colorectal cancer were also censored for recurrent colorectal cancer. The relationship between underlying demographics and clinical factors and the outcomes was assessed using a semi-competing risk approach. Results: The results of the multivariable analysis showed that having metastasis to other sites (hazard ratio = 36.03; 95% CI = 19.48-66.64) and higher pathological node (pN) stage (hazard ratio = 2.46; 95% CI = 1.32-4.56) were associated with a raised hazard of recurrence. The fewer chemotherapies (hazard ratio = 0.39; 95% CI = 0.17-0.88) and higher pN stages (hazard ratio = 4.32; 95% CI = 1.27-14.75) showed significantly higher hazards of death without recurrence. Having metastasis to other sites (hazard ratio = 2.67; 95% CI = 1.24-5.74) and higher pN stages (hazard ratio = 1.91; 95% CI = 1.02-3.61) were linked with the higher hazard of death after recurrence. Conclusion: Considering findings on death/recurrence-specific predictors obtained in this study to manage the outcomes in patients with colorectal cancer, tailored strategies for preventive and interventional plans should be deliberated.
AB - Background/Aims: Cancer studies suffer from an overestimation of prediction of survival when both recurrence and death are of interest. This longitudinal study aimed to mitigate this problem utilizing a semi-competing risk approach evaluating the factors affecting recurrence and postoperative death in patients with colorectal cancer. Materials and Methods: This longitudinal prospective study was conducted in 284 patients with resected colorectal cancer who were referred to the Imam Khomeini Clinic in Hamadan, Iran, during 2001-2017. Primary outcomes were postoperative outcomes and patient survival, including time to recurrence (of colorectal cancer), time to death, and time to death after recurrence. All patients who were alive at the end of the study were censored for death and who did not experience recurrence of colorectal cancer were also censored for recurrent colorectal cancer. The relationship between underlying demographics and clinical factors and the outcomes was assessed using a semi-competing risk approach. Results: The results of the multivariable analysis showed that having metastasis to other sites (hazard ratio = 36.03; 95% CI = 19.48-66.64) and higher pathological node (pN) stage (hazard ratio = 2.46; 95% CI = 1.32-4.56) were associated with a raised hazard of recurrence. The fewer chemotherapies (hazard ratio = 0.39; 95% CI = 0.17-0.88) and higher pN stages (hazard ratio = 4.32; 95% CI = 1.27-14.75) showed significantly higher hazards of death without recurrence. Having metastasis to other sites (hazard ratio = 2.67; 95% CI = 1.24-5.74) and higher pN stages (hazard ratio = 1.91; 95% CI = 1.02-3.61) were linked with the higher hazard of death after recurrence. Conclusion: Considering findings on death/recurrence-specific predictors obtained in this study to manage the outcomes in patients with colorectal cancer, tailored strategies for preventive and interventional plans should be deliberated.
KW - colorectal neoplasms
KW - Recurrence
KW - risk
KW - statistical model
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85164245299&partnerID=8YFLogxK
U2 - 10.5152/tjg.2023.22540
DO - 10.5152/tjg.2023.22540
M3 - Article
C2 - 37232463
AN - SCOPUS:85164245299
SN - 1300-4948
VL - 34
SP - 736
EP - 746
JO - Turkish Journal of Gastroenterology
JF - Turkish Journal of Gastroenterology
IS - 7
ER -
