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Sargent DJ, André T, Grothey A. Further Evaluating the Benefit of Adjuvant Chemotherapy for Colon Cancer. J Clin Oncol 2016; 34:3711-3712. [DOI: 10.1200/jco.2016.68.4886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Glimelius B, Hohenberger WM, Matzel KE, Sugihara K, Quirke P. Reply to D.J. Sargent et al. J Clin Oncol 2016; 34:3713-3714. [DOI: 10.1200/jco.2016.68.9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Klaus E. Matzel
- Chirurgische Klinik des Universitätsklinikums Erlangen, Erlangen, Germany
| | | | - Philip Quirke
- St James’s University Hospital, Leeds, United Kingdom
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Shi Q, Sargent DJ, Renfro LA. Findings from the Adjuvant Colon Cancer End Points (ACCENT) Collaborative Group: the Power of Pooled Individual Patient Data from Multiple Clinical Trials. CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shah MA, Renfro LA, Allegra CJ, André T, de Gramont A, Schmoll HJ, Haller DG, Alberts SR, Yothers G, Sargent DJ. Impact of Patient Factors on Recurrence Risk and Time Dependency of Oxaliplatin Benefit in Patients With Colon Cancer: Analysis From Modern-Era Adjuvant Studies in the Adjuvant Colon Cancer End Points (ACCENT) Database. J Clin Oncol 2016; 34:843-53. [PMID: 26811529 DOI: 10.1200/jco.2015.63.0558] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Fluorouracil plus leucovorin (FU + LV) adjuvant chemotherapy reduced the risk of recurrence and death across all time points in a pooled analysis of 20,898 patients with colon cancer from 18 randomized studies. The impact of oxaliplatin added to FU + LV on the time course of recurrence and survival remains unknown. PATIENTS AND METHODS A total of 12,233 patients enrolled to the randomized trials C-07, C-08, N0147, MOSAIC (Adjuvant Treatment of Colon Cancer), and XELOXA (Adjuvant XELOX) were pooled to examine the impact of oxaliplatin and tumor-specific factors on the time course of recurrence and death. For each end point, continuous-time risk was modeled over 6 years post treatment in all oxaliplatin-treated patients and patients concurrently randomized to FU + LV with or without oxaliplatin; the latter analyses supported time-dependent treatment comparisons. RESULTS Addition of oxaliplatin significantly reduced the risk of recurrence within the first 14 months post treatment for patients with stage II disease and within the first 4 years for patients with stage III disease. Oxaliplatin also significantly reduced risk of death from 2 to 6 years post treatment for patients with stage III disease, with no differences in timing of outcomes between treatment groups (ie, oxaliplatin did not simply postpone recurrence or death compared with FU + LV alone). Patients with stage II disease receiving oxaliplatin did not exhibit a significant reduction in risk of death in the first 6 years post treatment. Recurrence risk peaked near 14 months for both treatments, and risk of recurrence and death increased with increased tumor and nodal burden. CONCLUSIONS These analyses support the addition of oxaliplatin to fluoropyrimidine-based adjuvant therapy in patients with stage III disease and underscore the need for adequate surveillance of patients with colon cancer during the first 3 years after adjuvant therapy.
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Affiliation(s)
- Manish A Shah
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA.
| | - Lindsay A Renfro
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Carmen J Allegra
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Thierry André
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Aimery de Gramont
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Hans-Joachim Schmoll
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Daniel G Haller
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Steven R Alberts
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Greg Yothers
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Daniel J Sargent
- Manish A. Shah, Weill Cornell Medical College, New York/Presbyterian Hospital, New York, NY; Lindsay A. Renfro, Steven R. Alberts, and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Carmen J. Allegra, University of Florida, Gainesville, FL; Thierry André, Hôpital Saint Antoine, Paris; Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle, Germany; Daniel G. Haller, University of Pennsylvania, Philadelphia; and Greg Yothers, National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
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Renfro LA, Grothey A, Kerr D, Haller DG, André T, Van Cutsem E, Saltz L, Labianca R, Loprinzi CL, Alberts SR, Schmoll H, Twelves C, Yothers G, Sargent DJ. Survival following early-stage colon cancer: an ACCENT-based comparison of patients versus a matched international general population†. Ann Oncol 2015; 26:950-958. [PMID: 25697217 DOI: 10.1093/annonc/mdv073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/05/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Post-treatment survival experience of early colon cancer (CC) patients is well described in the literature, which states that cure is probable for some patients. However, comparisons of treated patients' survival versus that expected from a matched general population (MGP) are limited. PATIENTS AND METHODS A total of 32 745 patients from 25 randomized adjuvant trials conducted from 1977 to 2012 in 41 countries were pooled. Observed long-term survival of these patients was compared with expected survival matched on sex, age, country, and year, both overall and by stage (II and III), sex, treatment [surgery, 5-fluorouracil (5-FU), 5-FU + oxaliplatin], age (<70 and 70+), enrollment year (pre/post 2000), and recurrence (yes/no). Comparisons were made at randomization and repeated conditional on survival to 1, 2, 3, and 5 years. CC and MGP equivalence was tested, and observed Kaplan-Meier survival rates compared with expected MGP rates 3 years out from each landmark. Analyses were also repeated in patients without recurrence. RESULTS Within most cohorts, long-term survival of CC patients remained statistically worse than the MGP, though conditional survival generally improved over time. Among those surviving 5 years, stage II, oxaliplatin-treated, elderly, and recurrence-free patients achieved subsequent 3-year survival rates within 5% of the MGP, with recurrence-free patients achieving equivalence. CONCLUSIONS Conditional on survival to 5 years, long-term survival of most CC patients on clinical trials remains modestly poorer than an MGP, but achieves MGP levels in some subgroups. These findings emphasize the need for access to quality care and improved treatment and follow-up strategies.
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Affiliation(s)
- L A Renfro
- Division of Biomedical Statistics and Informatics.
| | - A Grothey
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - D Kerr
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - D G Haller
- School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - T André
- Hôpital Saint Antoine, Paris; Pierre and Marie Curie University, Paris, France
| | - E Van Cutsem
- Digestive Oncology Unit, University Hospital Gasthuisberg/Leuven, Leuven, Belgium
| | - L Saltz
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - R Labianca
- Oncology Unit, Ospedale Giovanni XXIII, Bergamo, Italy
| | - C L Loprinzi
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - S R Alberts
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - H Schmoll
- Department for Internal Medicine IV, University Clinic Halle, Halle, Germany
| | - C Twelves
- Leeds Institute of Cancer and Pathology, University of Leeds and St James's University Hospital, Leeds Cancer Research UK Centre, Leeds, UK
| | - G Yothers
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Pittsburgh, USA
| | - D J Sargent
- Division of Biomedical Statistics and Informatics
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Kopetz S, Tabernero J, Rosenberg R, Jiang ZQ, Moreno V, Bachleitner-Hofmann T, Lanza G, Stork-Sloots L, Maru D, Simon I, Capellà G, Salazar R. Genomic classifier ColoPrint predicts recurrence in stage II colorectal cancer patients more accurately than clinical factors. Oncologist 2015; 20:127-33. [PMID: 25561511 DOI: 10.1634/theoncologist.2014-0325] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Approximately 20% of patients with stage II colorectal cancer will experience a relapse. Current clinical-pathologic stratification factors do not allow clear identification of these high-risk patients. ColoPrint (Agendia, Amsterdam, The Netherlands, http://www.agendia.com) is a gene expression classifier that distinguishes patients with low or high risk of disease relapse. METHODS ColoPrint was developed using whole-genome expression data and validated in several independent validation cohorts. Stage II patients from these studies were pooled (n = 416), and ColoPrint was compared with clinical risk factors described in the National Comprehensive Cancer Network (NCCN) 2013 Guidelines for Colon Cancer. Median follow-up was 81 months. Most patients (70%) did not receive adjuvant chemotherapy. Risk of relapse (ROR) was defined as survival until first event of recurrence or death from cancer. RESULTS In the pooled stage II data set, ColoPrint identified 63% of patients as low risk with a 5-year ROR of 10%, whereas high-risk patients (37%) had a 5-year ROR of 21%, with a hazard ratio (HR) of 2.16 (p = .004). This remained significant in a multivariate model that included number of lymph nodes retrieved and microsatellite instability. In the T3 microsatellite-stable subgroup (n = 301), ColoPrint classified 59% of patients as low risk with a 5-year ROR of 9.9%. High-risk patients (31%) had a 22.4% ROR (HR: 2.41; p = .005). In contrast, the NCCN clinical high-risk factors were unable to distinguish high- and low-risk patients (15% vs. 13% ROR; p = .55). CONCLUSION ColoPrint significantly improved prognostic accuracy independent of microsatellite status or clinical variables, facilitating the identification of patients at higher risk who might be considered for additional treatment.
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Affiliation(s)
- Scott Kopetz
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Josep Tabernero
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Robert Rosenberg
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Zhi-Qin Jiang
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Víctor Moreno
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Thomas Bachleitner-Hofmann
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Giovanni Lanza
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Lisette Stork-Sloots
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Dipen Maru
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Iris Simon
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Gabriel Capellà
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
| | - Ramon Salazar
- Departments of Gastrointestinal Medical Oncology and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Surgery, Klinikum Rechts der Isar, Technische University, Munich, Germany; Institut Català d'Oncologia, IDIBELL L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, University of Ferrara, Ferrara, Italy; Agendia NV, Amsterdam, The Netherlands; Agendia Inc., Irvine, California, USA
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Böckelman C, Engelmann BE, Kaprio T, Hansen TF, Glimelius B. Risk of recurrence in patients with colon cancer stage II and III: a systematic review and meta-analysis of recent literature. Acta Oncol 2015; 54:5-16. [PMID: 25430983 DOI: 10.3109/0284186x.2014.975839] [Citation(s) in RCA: 245] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adjuvant chemotherapy is established routine therapy for colon cancer (CC) patients with radically resected stage III and 'high-risk' stage II disease. The decision on recommending adjuvant chemotherapy, however, is based on data from older patient cohorts not reflecting improvements in pre-operative staging, surgery, and pathological examination. The aim is to review the current risk of recurrence in stage II and III patients and second, to estimate the relative importance of routinely assessed clinico-pathological variables. METHODS The PubMed/MEDLINE and the Cochrane databases were systematically searched for randomized controlled studies and observational studies published after 1 January 2005 with patients included after January 1995 on prognosis in surgically treated stage II and III CC patients. RESULTS Of 2596 studies identified, 37 met the inclusion criteria and 25 provided data for meta-analysis. The total patient sample size in the 25 studies reporting either disease-free (DFS) or recurrence-free survival was 15 559 in stage II and 18 425 in stage III. Five-year DFS for stage II patients operated without subsequent adjuvant chemotherapy was 81.4% [95% confidence interval (CI) 75.4-87.4; in studies with good/very good quality of reporting 82.7%, (95% CI 80.8-84.6)]. For stage II patients treated with adjuvant chemotherapy, the five-year DFS was 79.3% (95% CI 75.6-83.1). For stage III patients without chemotherapy, five-year DFS was 49.0% (95% CI 23.2-74.8) and for those treated with adjuvant chemotherapy, 63.6% (95% CI 59.3-67.9). The prognostic impact of commonly investigated clinico-pathological parameters, (pT-stage, pN-stage, differentiation, number of lymph nodes studied, MMR-status, and emergency surgery) were confirmed. CONCLUSIONS In this meta-analysis, studies with good quality of reporting show a five-year DFS of 82.7% for stage II CC without adjuvant chemotherapy, whereas the five-year DFS is 63.8% for stage III CC with adjuvant chemotherapy. Due to insufficient reporting on treatment quality the presented DFS is likely an under-estimation of what is achieved at high-quality centers today.
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Affiliation(s)
- Camilla Böckelman
- Research Programs Unit, Translational Cancer Biology, University of Helsinki , Helsinki , Finland
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Dahl O, Pfeffer F. Twenty-five years with adjuvant chemotherapy for colon cancer--a continuous evolving concept. Acta Oncol 2015; 54:1-4. [PMID: 25263079 DOI: 10.3109/0284186x.2014.958533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Olav Dahl
- Section of Oncology, Institute of Clinical Science, MOF, University of Bergen and Department of Oncology, Haukeland University Hospital , Haukeland , Norway
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Nagayoshi K, Ueki T, Tashiro K, Mizuuchi Y, Manabe T, Araki H, Oda Y, Kuhara S, Tanaka M. Galanin plays an important role in cancer invasiveness and is associated with poor prognosis in stage II colorectal cancer. Oncol Rep 2014; 33:539-46. [PMID: 25504183 PMCID: PMC4306273 DOI: 10.3892/or.2014.3660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/20/2014] [Indexed: 12/13/2022] Open
Abstract
Reliable predictors of tumor recurrence for patients with stage II colorectal cancer (CRC) are needed to select patients who should receive adjuvant chemotherapy. Although galanin (GAL) is expressed in several malignant tumors and is associated with cell proliferation and tumor growth, the prognostic value of GAL expression in CRC is poorly understood. We compared GAL expression between 56 patients with stage II and III CRC who developed tumor recurrences and 56 patients who did not. The clinical and prognostic significance of GAL expression was examined using our data and independent public datasets. We also analyzed the influence of GAL expression on the proliferation and invasive activity of CRC cells. Higher expression of GAL was associated with tumor recurrence among the CRC patients (P<0.001). Stage II CRC patients who presented with high expression levels of GAL had significantly poorer prognosis than those with low expression levels of GAL [5-year overall survival: hazard ratio (HR), 7.31; 95% confidence interval (CI), 2.38–24.04; P<0.001; 5-year recurrence-free survival: HR, 3.99; 95% CI, 1.61–9.44; P=0.004], but there was no association between GAL expression and survival in stage III CRC patients. These findings were supported by analysis of two public datasets. Functionally, siRNA-mediated silencing of GAL resulted in a significant decrease in the proliferative and invasive activities of CRC cells. In conclusion, high expression of GAL is associated with poor prognosis of stage II CRC patients and GAL expression may be related to the aggressive behavior of CRC.
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Affiliation(s)
- Kinuko Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Higashi‑ku, Fukuoka 812-8582, Japan
| | - Takashi Ueki
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Higashi‑ku, Fukuoka 812-8582, Japan
| | - Kosuke Tashiro
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Higashi-ku, Fukuoka 812-8581, Japan
| | - Yusuke Mizuuchi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tatsuya Manabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Higashi‑ku, Fukuoka 812-8582, Japan
| | - Hiromitsu Araki
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Higashi-ku, Fukuoka 812-8581, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoru Kuhara
- Department of Bioscience and Biotechnology, Faculty of Agriculture, Kyushu University, Higashi-ku, Fukuoka 812-8581, Japan
| | - Masao Tanaka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Higashi‑ku, Fukuoka 812-8582, Japan
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60
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Costi R, Leonardi F, Zanoni D, Violi V, Roncoroni L. Palliative care and end-stage colorectal cancer management: The surgeon meets the oncologist. World J Gastroenterol 2014; 20:7602-7621. [PMID: 24976699 PMCID: PMC4069290 DOI: 10.3748/wjg.v20.i24.7602] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/09/2014] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is a common neoplasia in the Western countries, with considerable morbidity and mortality. Every fifth patient with CRC presents with metastatic disease, which is not curable with radical intent in roughly 80% of cases. Traditionally approached surgically, by resection of the primitive tumor or stoma, the management to incurable stage IV CRC patients has significantly changed over the last three decades and is nowadays multidisciplinary, with a pivotal role played by chemotherapy (CHT). This latter have allowed for a dramatic increase in survival, whereas the role of colonic and liver surgery is nowadays matter of debate. Although any generalization is difficult, two main situations are considered, asymptomatic (or minimally symptomatic) and severely symptomatic patients needing aggressive management, including emergency cases. In asymptomatic patients, new CHT regimens allow today long survival in selected patients, also exceeding two years. The role of colonic resection in this group has been challenged in recent years, as it is not clear whether the resection of primary CRC may imply a further increase in survival, thus justifying surgery-related morbidity/mortality in such a class of short-living patients. Secondary surgery of liver metastasis is gaining acceptance since, under new generation CHT regimens, an increasing amount of patients with distant metastasis initially considered non resectable become resectable, with a significant increase in long term survival. The management of CRC emergency patients still represents a major issue in Western countries, and is associated to high morbidity/mortality. Obstruction is traditionally approached surgically by colonic resection, stoma or internal by-pass, although nowadays CRC stenting is a feasible option. Nevertheless, CRC stent has peculiar contraindications and complications, and its long-term cost-effectiveness is questionable, especially in the light of recently increased survival. Perforation is associated with the highest mortality and remains mostly matter for surgeons, by abdominal lavage/drainage, colonic resection and/or stoma. Bleeding and other CRC-related symptoms (pain, tenesmus, etc.) may be managed by several mini-invasive approaches, including radiotherapy, laser therapy and other transanal procedures.
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Chamberlain MC. Conference Scene: Neuro-oncology: a selected review of ASCO 2013 abstracts. CNS Oncol 2013. [DOI: 10.2217/cns.13.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ASCO 2013 Annual Meeting, Chicago, IL, USA, 31 May–4 June 2013 The American Society of Clinical Oncology (ASCO) is the largest clinical oncology meeting in the USA that meets annually, and is an exciting forum in which new cancer clinical trials and research data are presented. The ASCO 2013 CNS tumors section comprising of 3 days of posters, oral presentations and over 100 abstracts provided a current overview of neuro-oncology, including both metastatic diseases of the CNS, as well as primary brain tumors. This brief overview selectively highlights presentations featured at this year’s meeting in a manner that will hopefully provide a portrait of a large and multifaceted meeting.
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Affiliation(s)
- Marc C Chamberlain
- Department of Neurology/Division of Neuro-Oncology, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Avenue E, POB 19023, MS G4940, Seattle, WA98109-1023, USA
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