The gap in postoperative outcome between older and younger patients with stage I-III colorectal cancer has been bridged; results from the Netherlands cancer registry

Brouwer, Nelleke; Heil, Thea C.; Rikkert, Marcel G M Olde; Lemmens, Valery; Rutten, H.J.T.; Wilt, Johannes H. W. de; Erning, Felice N. van

doi:10.1016/j.ejca.2019.04.036

Cited by 32 publications

(35 citation statements)

References 28 publications

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“…Compared with younger people, the 30-day mortality in the group of aged patients underestimates 1-year mortality due to prolonged impact of the perioperative period [8,18]. However, a recent Dutch study shows better postoperative outcome with almost equal 1-year survival rates for older and younger colorectal patients, supporting tailor-made decisions on surgical treatments for older patients [19].…”

Section: Introductionmentioning

confidence: 99%

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Niemeläinen

Huhtala

Ehrlich

et al. 2019

Int J Colorectal Dis

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Purpose Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged. Methods All patients > 80 years operated electively for stages I-III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data. Results A total of 386 patients (mean 84.0 years, range 80-96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33-39.55, p = 0.002). Conclusions The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

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Section: Introductionmentioning

confidence: 99%

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Niemeläinen

Huhtala

Ehrlich

et al. 2019

Int J Colorectal Dis

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“…To explore the impact of covariates included on the estimation, we will consider four groups of covariates for analysis: [1] We only focus on the colon cancer patients instead of colorectal cancer patients in NCR for two reasons: first in NCR, the treatment regimen for rectum cancer patients are much more complicated than colon cancer; second, reported by [29], the treatment effect of adjuvant chemotherapy didn't differ significantly by tumor site, namely, colon or rectum. 1 3 covariates: age, sex, and stage; 2 5 covariates: 2 covariates (age, sex) in addition to 3 covariates in the guideline (stage, MSI, high risk [2] ); 3 13 covariates: 2 covariates (age, sex) in addition to 11 covariates in the guideline (stage, cM, pT, pN, high risk, MSI, number of lymph nodes assessed, colon perforation, lymphomatic invasie, agio invasie, grade); 4 All covariates in Table 1 3 Controlling for confounding: Direct, IPW, and DR methods…”

Section: The Ncrmentioning

confidence: 99%

“…and positivity (or overlap) 0 < P (Z = 1|X) < 1. (4) [2] risk factors implied in the 2014 Dutch guideline for colon cancer [31]: perforation at diagnosis = yes, pT = 4, lymphatic invasion = yes, angio invasion = EMVI or IMVI, grade = poor to undifferentiated or unknown, the number of lymph nodes assessed less than 10. As long as one of risk factors occurs in stage II patients, patients are identified as 'high risk = high'.…”

Section: Covariates Description and Data Processingmentioning

confidence: 99%

“…Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide in 2018 [1]. The majority of patients are curatively treated with surgical removal of the tumor, surrounding tissues, and lymph nodes leading to excellent long term survival [2]. For stage III colon cancer, Randomized Control Trials (RCTs) [3][4][5] have shown an improved overall survival when surgery is followed by adjuvant chemotherapy compared to surgery only.…”

Section: Introductionmentioning

confidence: 99%

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Estimating the effect of adjuvant chemo-therapy for colon-cancer using registry data: a method comparison and validation

Shen¹,

Visser²,

Wilt³

et al. 2020

Preprint

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Background: Although randomized controlled trials (RCT) are the gold standard to estimate treatment effects, they are often criticized in terms of generalizability. Observational data might alleviate this problem by being readily available in large quantities. However, observational data are potentially confounded. In this methodological study we use a large-scale RCT as the gold standard to examine the performance of various statistical methods to control for potential confounding in observational data. Methods: In this paper we compare three types of methods that allow researchers to correct for such potential confounding: direct methods, inverse probability weighting (IPW) methods and doubly robust (DR) methods. We uniquely compare estimates obtained from the population-wide Netherlands Cancer Registry (NCR) on colon cancer (n=52621) with estimates obtained from a large-scale RCT. As the RCT differs from the observational data both in its sampling mechanism and in its treatment assignment mechanism, we first resample the NCR data to reflect the distribution in RCT data. Next, we correct for potential confounding using three alternative types of methods and consequentially evaluate their estimates to those obtained in the RCT. Results: We find that while all estimators qualitatively approximate to findings in the RCT, methods that can flexibly model the response (i.e., direct estimation and DR estimation) performed consistently superior to the inverse propensity score method. Subgroup analysis indicates that relatively simple models allow us to properly estimate the treatment effect. However, these simple models do not properly identify heterogeneous treatment effects in stage2 colon cancer. Careful sensitivity analysis using more flexible models demonstrates both the uncertainty and the potential heterogeneous treatment effect in stage2 cancer and provides robust estimation of treatment effect in stage3 cancer. Conclusions: Our results suggest that both the direct method and the DR method, when executed with care, can be used to reliably estimate treatment effects based on registry data. This methodological validation opens the door to more extensive use of registry data for the estimation of (individual) treatment effects. Additionally, our identification of potentially meaningful subgroups of stage2 colon cancer patients who, based on our analysis seem to benefit from chemotherapy, should be further explored.

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“…Some studies evince that older patients get lower overall and disease-free survival rates, while others show barely any difference. The reasons for the worse prognosis are the increase in comorbidities, low socioeconomic status, and high treatment refusal rate of older patients [3,4].…”

mentioning

confidence: 99%

Comprehensive Approach for Older Cancer Patients: New Challenge in an Aging Society

Lee

Kwak

2020

Ann Coloproctol

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The gap in postoperative outcome between older and younger patients with stage I-III colorectal cancer has been bridged; results from the Netherlands cancer registry

Cited by 32 publications

References 28 publications

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Estimating the effect of adjuvant chemo-therapy for colon-cancer using registry data: a method comparison and validation

Comprehensive Approach for Older Cancer Patients: New Challenge in an Aging Society

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