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. 2023 Jul;34(7):736-746.
doi: 10.5152/tjg.2023.22540.

Recurrence and Postoperative Death in Patients with Colorectal Cancer: A New Perspective via Semi-competing Risk Framework

Malihe Safari  1 , Leila Mahmoudi  2 , Emma K Baker  3 , Ghodratollah Roshanaei  4 , Ramazan Fallah  2 , Ali Shahnavaz  5 , Mohammad Asghari-Jafarabadi  6
Affiliations

Recurrence and Postoperative Death in Patients with Colorectal Cancer: A New Perspective via Semi-competing Risk Framework

Malihe Safari et al. Turk J Gastroenterol. 2023 Jul.

Abstract

Background/aims: Cancer studies suffer from an overestimation of prediction of survival when both recurrence and death are of interest. This longitudinal study aimed to mitigate this problem utilizing a semi-competing risk approach evaluating the factors affecting recurrence and postoperative death in patients with colorectal cancer.

Materials and methods: This longitudinal prospective study was conducted in 284 patients with resected colorectal cancer who were referred to the Imam Khomeini Clinic in Hamadan, Iran, during 2001-2017. Primary outcomes were postoperative outcomes and patient survival, including time to recurrence (of colorectal cancer), time to death, and time to death after recurrence. All patients who were alive at the end of the study were censored for death and who did not experience recurrence of colorectal cancer were also censored for recurrent colorectal cancer. The relationship between underlying demographics and clinical factors and the outcomes was assessed using a semicompeting risk approach.

Results: The results of the multivariable analysis showed that having metastasis to other sites (hazard ratio = 36.03; 95% CI = 19.48- 66.64) and higher pathological node (pN) stage (hazard ratio = 2.46; 95% CI = 1.32-4.56) were associated with a raised hazard of recurrence. The fewer chemotherapies (hazard ratio = 0.39; 95% CI = 0.17-0.88) and higher pN stages (hazard ratio = 4.32; 95% CI = 1.27-14.75) showed significantly higher hazards of death without recurrence. Having metastasis to other sites (hazard ratio = 2.67; 95% CI = 1.24-5.74) and higher pN stages (hazard ratio = 1.91; 95% CI = 1.02-3.61) were linked with the higher hazard of death after recurrence.

Conclusion: Considering findings on death /recu rrenc e-spe cific predictors obtained in this study to manage the outcomes in patients with colorectal cancer, tailored strategies for preventive and interventional plans should be deliberated.

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Conflict of interest statement

Declaration of Interests: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Graphical representation of semi-competing risks.
Figure 2.
Figure 2.
Adjusted survival probability for the events according to the metastasis to other sites.
Figure 3.
Figure 3.
Adjusted survival probability for the events according to the number of chemotherapies.
Figure 4.
Figure 4.
Adjusted survival probability for the events according to the pN stage.
See this image and copyright information in PMC

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