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- Title
Informing metastatic colorectal cancer patients by quantifying multiple scenarios for survival time based on real‐life data.
- Authors
Hamers, Patricia A. H.; Elferink, Marloes A. G.; Stellato, Rebecca K.; Punt, Cornelis J. A.; May, Anne M.; Koopman, Miriam; Vink, Geraldine R.
- Abstract
Reported median overall survival (mOS) in metastatic colorectal cancer (mCRC) patients participating in systemic therapy trials has increased to over 30 months. It is uncertain whether trial results translate to real‐life populations. Moreover, patients prefer presentation of multiple survival scenarios. Population‐based data of all stage IV CRC patients diagnosed between 2008 and 2016 were obtained from the Netherlands Cancer Registry, which has a case ascertainment completeness surpassing 95%. We calculated the following percentiles (scenarios) of OS per year of diagnosis for the total population, and for treatment subgroups: 10th (best‐case), 25th (upper‐typical), 50th (median), 75th (lower‐typical) and 90th (worst‐case). Twenty‐five percent of patients did not receive any antitumor treatment. From 2008 to 2016, mOS of the total population (n = 27275) remained unchanged at approximately 12 months. OS improved only for the upper‐typical and best‐case patients; by 4.2 to 29.1 months (P <.001), and by 6 to 62 months (P <.001), respectively. No clinically relevant change was observed among patients who received systemic therapy, with mOS close to 15 months and best‐case scenario approximately 40 months. A clinically relevant improvement in survival over time was observed in patients who initially received metastasectomy and/or HIPEC only. In contrast to the wide belief based on trial data that mOS of mCRC patients receiving systemic therapy has improved substantially, improvement could not be demonstrated in our real‐life population. Clinicians should consider quoting multiple survival scenarios based on real‐life data instead of point estimates from clinical trials, when informing patients about their life expectancy. What's new? Clinical trials on first‐line systemic therapy in metastatic colorectal cancer (mCRC) patients suggest a marked improvement in median overall survival (mOS). However, uncertainty exists in how the survival reported in trials relates to the real‐life mCRC population. This is the first population‐based study providing multiple scenarios for patient survival. The results show that real‐life mCRC patients receiving systemic therapy have a shorter mOS compared to trial patients, likely reflecting patient selection in clinical trials. Clinicians should consider presenting multiple scenarios for survival based on real‐life data instead of point estimates from clinical trials when informing patients about their life expectancy.
- Subjects
SURVIVAL analysis (Biometry); COLORECTAL cancer; METASTASIS; CANCER patients; PATIENT selection; HEREDITARY nonpolyposis colorectal cancer
- Publication
International Journal of Cancer, 2021, Vol 148, Issue 2, p296
- ISSN
0020-7136
- Publication type
Article
- DOI
10.1002/ijc.33200