1. Multi-state relative survival modelling of colorectal cancer progression and mortality
- Author
-
Ella Huszti, Christine Binquet, Olivier Dejardin, Anne-Marie Bouvier, Séverine Gilard-Pioc, Catherine Quantin, Michal Abrahamowicz, and Amel Mahboubi
- Subjects
Oncology ,Male ,Cancer Research ,medicine.medical_specialty ,Epidemiology ,Colorectal cancer ,01 natural sciences ,Cancer recurrence ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Registries ,0101 mathematics ,Stage (cooking) ,Aged ,Neoplasm Staging ,Models, Statistical ,Multi state ,Relative survival ,business.industry ,Proportional hazards model ,Cancer ,medicine.disease ,Prognosis ,3. Good health ,Surgery ,Survival Rate ,030220 oncology & carcinogenesis ,Curative surgery ,Disease Progression ,Female ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms - Abstract
Accurate identification of factors associated with progression of colorectal cancer remains a challenge. In particular, it is unclear which statistical methods are most suitable to separate the effects of putative prognostic factors on cancer progression vs cancer-specific and other cause mortality. To address these challenges, we analyzed 10 year follow-up data for patients who underwent curative surgery for colorectal cancer in 1985–2000. Separate analyses were performed in two French cancer registries. Results of three multivariable models were compared: Cox model with recurrence as a time-dependent variable, and two multi-state models, which separated prognostic factor effects on recurrence vs death, with or without recurrence. Conventional multi-state model analyzed all-cause mortality while new relative survival multi-state model focused on cancer-specific mortality. Among the 2517 and 2677 patients in the two registries, about 50% died without a recurrence, and 28% had a recurrence, of whom almost 90% died. In both multi-state models men had significantly increased risk of cancer recurrence in both registries (HR = 0.79; 95% CI: 0.68–0.92 and HR = 0.83; 95% CI: 0.71–0.96). However, the two multi-state models identified different prognostic factors for mortality without recurrence. In contrast to the conventional model, in the relative survival analyses gender had no independent association with cancer-specific mortality whereas patients diagnosed with stage III cancer had significantly higher risks in both registries (HR = 1.67; 95% CI: 1.27–2.22 and HR = 2.38; 95% CI: 1.29–3.27). In conclusion, relative survival multi-state model revealed that different factors may be associated with cancer recurrence vs cancer-specific mortality either after or without a recurrence.
- Published
- 2014