1
|
Survival outcomes associated with Lynch syndrome colorectal cancer and metachronous rate after subtotal/total versus segmental colectomy: Meta-analysis. Surgery 2022; 172:1315-1322. [PMID: 36031446 DOI: 10.1016/j.surg.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lynch syndrome is associated with the most common form of heritable bowel cancer. There remains limited level 1 evidence on survival outcomes and rate of metachronous tumor associated with Lynch syndrome colorectal cancer. METHODS A systematic literature search of original studies was performed on Ovid searching MEDLINE, Embase, Cochrane Database of Systematic Reviews, American College of Physicians ACP Journal Club, Database of Abstracts of Reviews of Effects DARE, and Clinical Trials databases from inception of database to February 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. The data were pooled using a random-effects model. All of the P values were 2-tailed, and statistical analysis was performed using RevMan v. 5.3 Cochrane Collaboration. RESULTS From 1,942 studies, 15 studies met the inclusion criteria and were included for qualitative and quantitative synthesis. The five-year overall survival was 89.5% (82.0-94.1%), P < .01; I2 = 89%. The ten-year overall survival was 80.5% (68.7-88.6%), P < .01; I2 = 81%. The fifteen-year overall survival was 70% (33.7%-91.5%), P < .01; I2 = 93%. Univariate meta-regression analysis showed no statistically significant difference in 5-year overall survival by sex, age, MLH1, MSH2, MSH6, nor tumor location (right versus left colon). The metachronous tumor rate was 12% to 33% with a follow-up period of up to 15 years, significantly lower in patients who underwent subtotal/total colectomy (0-6%). CONCLUSION The overall survival of patients with colorectal cancer with Lynch syndrome was approximately 90% at 5 years, 80% at 10 years, and 70% at 15 years. The metachronous tumor rate was approximately 10% to 30% at up to 15 years, significantly improved by subtotal/total colectomy.
Collapse
|
2
|
Surbakti E, Simaremare SA, Pasaribu RD. The Empowerment of Women of Childbearing Age through Participatory Action Research in Preventing Cervical Cancer. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aims to explore and analyze the effect of empowering women of childbearing age through the participatory action research method on cervical cancer prevention.
SETTINGS AND DESIGN: This was qualitative and quantitative approaches.
METHODS: A participatory action research approach to empower women of childbearing age and a quantitative pre-test and post-test without control approach was used to assess the changes that occur. Statistical analysis used: Paired t-test, to find out the mean difference before and after empowerment. Empowerment affects social changes in women of childbearing age in the prevention of cervical cancer. The Perwiritan and Moria groups not only carry out religious activities but also socialization and cervical cancer prevention campaigns.
RESULTS: The results showed that empowerment had an effect on increasing the average score of knowledge, attitudes, and actions of women of childbearing age in preventing cervical cancer (p < 0.05).
DISCUSSION: Empowerment of women of childbearing age is very effective in creating awareness, knowledge, attitudes, and actions in cervical cancer prevention. Empowerment can also be done for women in other communities.
CONCLUSION: There is an increase in understanding of women of childbearing age and the situation in which PAR is carried out because of the emergence of change agents among women of childbearing age who continue to have dialectics.
Collapse
|
3
|
Arif AA, Chahal D, Ladua GK, Bhang E, Salh B, Rosenfeld G, Loree JM, Donnellan F. Hereditary and Inflammatory Bowel Disease-Related Early Onset Colorectal Cancer Have Unique Characteristics and Clinical Course Compared with Sporadic Disease. Cancer Epidemiol Biomarkers Prev 2021; 30:1785-1791. [PMID: 34301727 DOI: 10.1158/1055-9965.epi-21-0507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early onset colorectal cancer (EoCRC), diagnosed in those <50 years old, is increasing in incidence. We sought to differentiate characteristics and outcomes of EoCRC in patients with sporadic disease or preexisting conditions. METHODS We evaluated 2,135 patients with EoCRC in a population-based cohort from the Canadian province of British Columbia. Patients were identified on the basis of presence of hereditary syndromes (n = 146) or inflammatory bowel disease (IBD; n = 87) and compared with patients with sporadic EoCRC (n = 1,902). RESULTS Proportions of patients with preexisting conditions were highest in the youngest decile of 18-29 (34.3%, P < 0.0001). Patients with sporadic EoCRC were older, more likely female, and had increased BMI (P < 0.05). IBD-related EoCRC had the highest rates of metastatic disease, poor differentiation, adverse histology, lymphovascular, and perineural invasion (P < 0.05). Survival was lower in patients with IBD (HR, 1.80; 95% CI, 1.54-3.13; P < 0.0001) and higher in hereditary EoCRC (HR, 0.47; 95% CI, 0.45-0.73; P < 0.0001) compared with sporadic. Prognosis did not differ between ulcerative colitis or Crohn's disease but was lower in those with undifferentiated-IBD (HR, 1.87; 95% CI, 1.01-4.05; P = 0.049). Lynch syndrome EoCRC had improved survival over familial adenomatous polyposis (HR, 0.31; 95% CI, 0.054-0.57; P = 0.0037) and other syndromes (HR, 0.43; 95% CI, 0.11-0.99; P = 0.049). In multivariate analysis controlling for prognostic factors, hereditary EoCRC was unchanged from sporadic; however, IBD-related EoCRC had worse overall survival (HR, 2.21; 95% CI, 1.55-3.16; P < 0.0001). CONCLUSIONS EoCRC is heterogenous and patients with preexisting conditions have different characteristics and outcomes compared with sporadic disease. IMPACT Prognostic differences identified here for young patients with colorectal cancer and predisposing conditions may help facilitate treatment planning and patient counseling.See related commentary by Hayes, p. xxx.
Collapse
Affiliation(s)
- Arif A Arif
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daljeet Chahal
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gale K Ladua
- Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric Bhang
- Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Bill Salh
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Rosenfeld
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan M Loree
- Division of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada.
| | - Fergal Donnellan
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Aday U, Kafadar MT, Oğuz A, Bahadir MV, Demir B, Akpulat FV, Gulturk B, Böyük A. Polyposis and Oncologic Outcomes in Young-onset Sporadic Colorectal Cancer. Euroasian J Hepatogastroenterol 2021; 11:6-10. [PMID: 34316457 PMCID: PMC8286364 DOI: 10.5005/jp-journals-10018-1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim The present study aimed to investigate the effect of the presence of polyposis in sporadic early-onset colorectal cancer (EOCRC) on clinicopathological and oncological outcomes. Methods The retrospective study included patients with sporadic colorectal cancer aged 16 to 50 years who underwent curative resection at the general surgery clinics in two healthcare centers between 2013 and 2019. Patients were divided into two groups: polyposis and nonpolyposis. Clinicopathological characteristics and oncological outcomes were compared between the two groups. Results A total of 127 patients were included, of whom 60.6% were men. There were 25 (19.68%) patients in the polyposis group and 102 (80.31%) patients in the nonpolyposis group. Seventy-one (69.6%) of the nonpolyposis group and 23 (92.0%) of the polyposis group had adenocarcinoma histological types. The total number of patients with mucinous tumor and signet ring cell carcinoma in the nonpolyposis and polyposis groups was 31 (30.4%) and 2 (8.0%), respectively (p = 0.042). Five-year overall survival (OS) was 60 and 72% in the nonpolyposis and polyposis groups, respectively, and no significant difference was found (p = 0.332). In univariate analysis, American Joint Committee on Cancer (AJCC) tumor stage (pT) ≥3–4, lymph node positivity, presence of mucinous tumor and signet ring cell carcinoma, lymphovascular invasion, and advanced tumor-lymph nodesmetastasis (TNM) stage (III–IV) were found to be significant negative prognostic factors for OS, whereas none of these parameters were found to be prognostic factors in multivariate analysis. The presence of polyposis was not a significant factor on both univariate and multivariate analyses. Conclusion Although the sporadic EOCRC cases developing on the basis of polyposis can have slightly better oncological outcomes, these outcomes are mostly similar to those of cases with nonpolyposis. How to cite this article Aday U, Kafadar MT, Oğuz A, et al. Polyposis and Oncologic Outcomes in Young-onset Sporadic Colorectal Cancer. Euroasian J Hepato-Gastroenterol 2021;11(1):6–10.
Collapse
Affiliation(s)
- Ulas Aday
- Department of Gastrointestinal Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mehmet T Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Mehmet V Bahadir
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Baran Demir
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Faik V Akpulat
- Department of General Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Baris Gulturk
- Department of General Surgery, University of Healty Sciences, Elazig Training and Research Hospital, Elazig, Turkey
| | - Abdullah Böyük
- Department of General Surgery, Elaziğ City Hospital, Turkey
| |
Collapse
|
5
|
Lindberg LJ, Ladelund S, Frederiksen BL, Smith-Hansen L, Bernstein I. Outcome of 24 years national surveillance in different hereditary colorectal cancer subgroups leading to more individualised surveillance. J Med Genet 2016; 54:297-304. [PMID: 28039328 DOI: 10.1136/jmedgenet-2016-104284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/18/2016] [Accepted: 11/27/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Individuals with hereditary non-polyposis colorectal cancer (HNPCC) have a high risk of colorectal cancer (CRC). The benefits of colonic surveillance in Lynch syndrome and Amsterdam-positive (familial CRC type X familial colorectal cancer type X (FCCTX)) families are clear; only the interval between colonoscopies is debated. The potential benefits for families not fulfilling the Amsterdam criteria are uncertain. The aim of this study was to compare the outcome of colonic surveillance in different hereditary subgroups and to evaluate the surveillance programmes. METHODS A prospective, observational study on the outcome of colonic surveillance in different hereditary subgroups based on 24 years of surveillance data from the national Danish HNPCC register. RESULTS We analysed 13 444 surveillance sessions, including 8768 incidence sessions and 20 450 years of follow-up. CRC was more incident in the Lynch subgroup (2.0%) than in any other subgroup (0.0-0.4%, p<0.0001), but the incidence of advanced adenoma did not differ between the Lynch (3.6%) and non-Lynch (2.3-3.9%, p=0.28) subgroups. Non-Lynch Amsterdam-positive and Amsterdam-negative families were similar in their CRC (0.1-0.4%, p=0.072), advanced adenoma (2.3-3.3%, p=0.32) and simple adenoma (8.4-9.9%, p=0.43) incidence. In moderate-risk families, no CRC and only one advanced adenoma was found. CONCLUSIONS The risk of CRC in Lynch families is considerable, despite biannual surveillance. We suggest less frequent and more individualised surveillance in non-Lynch families. Individuals from families with a strong history of CRC could be offered 5-year surveillance colonoscopies (unless findings at the preceding surveillance session indicate shorter interval) and individuals from moderate-risk families could be handled with the population-based screening programme for CRC after an initial surveillance colonoscopy.
Collapse
Affiliation(s)
- Lars Joachim Lindberg
- Danish HNPCC register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Steen Ladelund
- Danish HNPCC register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Lars Smith-Hansen
- Danish HNPCC register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Inge Bernstein
- Danish HNPCC register, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Surgical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
6
|
Nishihara R, VanderWeele TJ, Shibuya K, Mittleman MA, Wang M, Field AE, Giovannucci E, Lochhead P, Ogino S. Molecular pathological epidemiology gives clues to paradoxical findings. Eur J Epidemiol 2015; 30:1129-35. [PMID: 26445996 PMCID: PMC4639412 DOI: 10.1007/s10654-015-0088-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/26/2015] [Indexed: 12/23/2022]
Abstract
A number of epidemiologic studies have described what appear to be paradoxical associations, where an incongruous relationship is observed between a certain well-established risk factor for disease incidence and favorable clinical outcome among patients with that disease. For example, the "obesity paradox" represents the association between obesity and better survival among patients with a certain disease such as coronary heart disease. Paradoxical observations cause vexing clinical and public health problems as they raise questions on causal relationships and hinder the development of effective interventions. Compelling evidence indicates that pathogenic processes encompass molecular alterations within cells and the microenvironment, influenced by various exogenous and endogenous exposures, and that interpersonal heterogeneity in molecular pathology and pathophysiology exists among patients with any given disease. In this article, we introduce methods of the emerging integrative interdisciplinary field of molecular pathological epidemiology (MPE), which is founded on the unique disease principle and disease continuum theory. We analyze and decipher apparent paradoxical findings, utilizing the MPE approach and available literature data on tumor somatic genetic and epigenetic characteristics. Through our analyses in colorectal cancer, renal cell carcinoma, and glioblastoma (malignant brain tumor), we can readily explain paradoxical associations between disease risk factors and better prognosis among disease patients. The MPE paradigm and approach can be applied to not only neoplasms but also various non-neoplastic diseases where there exists indisputable ubiquitous heterogeneity of pathogenesis and molecular pathology. The MPE paradigm including consideration of disease heterogeneity plays an essential role in advancements of precision medicine and public health.
Collapse
Affiliation(s)
- Reiko Nishihara
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, 02115, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA, 02215, USA.
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave., Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave., Boston, MA, 02115, USA
| | - Alison E Field
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave., Boston, MA, 02115, USA
- Division of Adolescent Medicine, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
- Department of Epidemiology, Brown University, 121 South Main Street, Providence, RI, 02912, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave., Boston, MA, 02115, USA
| | - Paul Lochhead
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA, 02215, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA.
- Department of Pathology, Brigham and Women's Hospital, Boston, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
7
|
Son IT, Kim DW, Jeong SY, Shin YK, Ihn MH, Oh HK, Kang SB, Park KJ, Oh JH, Ku JL, Park JG. Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades. Cancer Res Treat 2015; 48:605-11. [PMID: 26044163 PMCID: PMC4843708 DOI: 10.4143/crt.2015.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/16/2015] [Indexed: 01/08/2023] Open
Abstract
Purpose The Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients. Materials and Methods Data on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time. Results The period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly—period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001). Conclusion Colorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry’s establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.
Collapse
Affiliation(s)
- Il Tae Son
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Hereditary Tumor Registry, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Korean Hereditary Tumor Registry, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young-Kyoung Shin
- Korean Hereditary Tumor Registry, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Ja-Lok Ku
- Korean Hereditary Tumor Registry, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Gahb Park
- Korean Hereditary Tumor Registry, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| |
Collapse
|
8
|
Phipps AI, Ahnen DJ, Campbell PT, Win AK, Jenkins MA, Lindor NM, Gryfe R, Potter JD, Newcomb PA. Family history of colorectal cancer is not associated with colorectal cancer survival regardless of microsatellite instability status. Cancer Epidemiol Biomarkers Prev 2014; 23:1700-4. [PMID: 24891550 DOI: 10.1158/1055-9965.epi-14-0533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Individuals with a family history of colorectal cancer in first-degree relatives have an elevated risk of developing colorectal cancer themselves, particularly colorectal cancer exhibiting high microsatellite instability (MSI-high). Given that MSI-high colorectal cancer is associated with a favorable prognosis, it is plausible that having a family history of colorectal cancer could, in turn, be favorably associated with colorectal cancer survival. METHODS This study comprised N = 4,284 incident colorectal cancer cases enrolled in the Colon Cancer Family Registry via population-based cancer registries. Using Cox proportional hazards regression, we evaluated the association between family history and both overall and disease-specific survival, accounting for MSI status and tumor site via stratified analyses and statistical adjustment. RESULTS There was no evidence of association between family history and overall [hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.79-1.08] or disease-specific survival (HR, 1.03; 95% CI, 0.85-1.24) for all cases combined, after adjustment for MSI status or tumor site. Only for rectal cancer cases was colorectal cancer family history modestly associated with more favorable overall survival (HR, 0.75; 95% CI, 0.56-0.99). CONCLUSIONS Although individuals with a family history of colorectal cancer were more likely to have MSI-high tumors than those with nonfamilial disease, this did not translate to a survival benefit. IMPACT Overall, there is no evidence that family history of colorectal cancer is associated with colorectal cancer survival; however, specific mechanisms underlying family history may have prognostic impact and merit further study.
Collapse
Affiliation(s)
- Amanda I Phipps
- Epidemiology Department, University of Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington;
| | - Dennis J Ahnen
- Division of Gastroenterology, University of Colorado School of Medicine, Denver, Colorado
| | - Peter T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Robert Gryfe
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and
| | - John D Potter
- Epidemiology Department, University of Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Polly A Newcomb
- Epidemiology Department, University of Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
9
|
Kaplan R, Maughan T, Crook A, Fisher D, Wilson R, Brown L, Parmar M. Evaluating many treatments and biomarkers in oncology: a new design. J Clin Oncol 2013; 31:4562-8. [PMID: 24248692 PMCID: PMC4394353 DOI: 10.1200/jco.2013.50.7905] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a pressing need for more-efficient trial designs for biomarker-stratified clinical trials. We suggest a new approach to trial design that links novel treatment evaluation with the concurrent evaluation of a biomarker within a confirmatory phase II/III trial setting. We describe a new protocol using this approach in advanced colorectal cancer called FOCUS4. The protocol will ultimately answer three research questions for a number of treatments and biomarkers: (1) After a period of first-line chemotherapy, do targeted novel therapies provide signals of activity in different biomarker-defined populations? (2) If so, do these definitively improve outcomes? (3) Is evidence of activity restricted to the biomarker-defined groups? The protocol randomizes novel agents against placebo concurrently across a number of different biomarker-defined population-enriched cohorts: BRAF mutation; activated AKT pathway: PI3K mutation/absolute PTEN loss tumors; KRAS and NRAS mutations; and wild type at all the mentioned genes. Within each biomarker-defined population, the trial uses a multistaged approach with flexibility to adapt in response to planned interim analyses for lack of activity. FOCUS4 is the first test of a protocol that assigns all patients with metastatic colorectal cancer to one of a number of parallel population-enriched, biomarker-stratified randomized trials. Using this approach allows questions regarding efficacy and safety of multiple novel therapies to be answered in a relatively quick and efficient manner, while also allowing for the assessment of biomarkers to help target treatment.
Collapse
Affiliation(s)
- Richard Kaplan
- Richard Kaplan, Angela Crook, David Fisher, Louise Brown, and Mahesh Parmar, Medical Research Council Clinical Trials Unit, London; Timothy Maughan, University of Oxford, Oxford; and Richard Wilson, Queen's University Belfast, Belfast, United Kingdom
| | | | | | | | | | | | | |
Collapse
|