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. 2017 Aug:49:186-194.
doi: 10.1016/j.canep.2017.07.001. Epub 2017 Jul 12.

Survival after recurrence of stage I-III breast, colorectal, or lung cancer

Michael J Hassett  1 , Hajime Uno  2 , Angel M Cronin  3 , Nikki M Carroll  4 , Mark C Hornbrook  5 , Paul Fishman  6 , Debra P Ritzwoller  4
Affiliations

Survival after recurrence of stage I-III breast, colorectal, or lung cancer

Michael J Hassett et al. Cancer Epidemiol. 2017 Aug.

Abstract

Background: The experiences of patients with recurrent cancer are assumed to reflect those of patients with de novo stage IV disease; yet, little is truly known because most registries lack recurrence status. Using two databases with excellent recurrence and death information, we examined determinants of survival duration after recurrence of breast (BC), colorectal (CRC), and lung cancers (LC).

Methods: Recurrence status was abstracted from the medical records of patients who participated in the Cancer Care Outcomes Research and Surveillance study and who received care at two Cancer Research Network sites-the Colorado and Northwest regions of Kaiser Permanente. The analysis included 1653 patients who developed recurrence after completing definitive therapy for stages I-III cancer. Multivariable modeling identified independent determinants of survival duration after recurrence, controlling for other factors.

Results: Through 60 months' average follow-up, survival after recurrence for BC, CRC, and LC were 28.4, 23.1 and 16.1 months, respectively. Several factors were independently associated with shorter survival for all three cancers, including higher initial stage (III vs. I: BC -9.9 months; CRC -6.9 months; LC -7.4 months; P≤0.01). Factors associated with shorter survival for selected cancers included: distant/regional recurrence for BC and CRC; current/former smoker for LC; high grade for CRC; and <4-year time-to-recurrence for BC.

Conclusions: Initial stage predicts survival duration after recurrence, whereas time-to-recurrence usually does not. The impact of biologic characteristics (e.g., grade, hormone-receptor status) on survival duration after recurrence needs further study. Predictors of survival duration after recurrence may help facilitate patient decision-making.

Keywords: Breast cancer; Colorectal cancer; Lung cancer; Natural history; Outcomes; Recurrence; Survival.

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Figures

Figure 1
Figure 1. Flow diagram of breast, colorectal and lung cancer patients from the CRN and CanCORS who were included in this analysis
For the Cancer Research Network (CRN) cohort, inclusion criteria included: first cancer diagnosis only (i.e., no previous cancer diagnosis), enrolled in one of two participating CRN institutions at diagnosis, and at least age 21 at diagnosis. For the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) cohort, inclusion criteria included: CanCORS participant, first cancer diagnosis only (i.e., no previous cancer diagnosis), at least age 21 at diagnosis, and both baseline interview and medical record abstraction data were available. CanCORS only enrolled colorectal and lung cancer patients so did not contribute breast cancer patients to this analysis. Patients from Kaiser Permanente Northwest who enrolled in CanCORS were excluded from the CanCORS cohort, because they were part of the CRN cohort. All patients must have had stage I–III cancer (excluding stage IIIb lung cancer) treated with definitive local therapy within 365 days after the initial cancer diagnosis. Also, patients must have been followed for >1 day after recurrence (only one patient, from the CRN with colorectal cancer, was excluded due to lack of follow-up after recurrence).
Figure 2
Figure 2. Kaplan-Meier plots of overall survival following recurrence through 60 months of follow-up for patients with breast (panel A), colorectal (panel B), and lung (panel C) cancer
Outcomes were stratified by type of recurrence (local vs. distant/regional) in panels A1–C1; stage at initial cancer diagnosis (I, II, and III) in panels A2–C2; and time from initial cancer diagnosis to recurrence (0 to 1, >1 to 2, >2 to 4, and >4 years) in panels A3–C3.
See this image and copyright information in PMC

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