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- Title
ACCENT-Based Web Calculators to Predict Recurrence and Overall Survival in Stage III Colon Cancer.
- Authors
Renfro, Lindsay A.; Grothey, Axel; Yuan Xue; Saltz, Leonard B.; André, Thierry; Twelves, Chris; Labianca, Roberto; Allegra, Carmen J.; Alberts, Steven R.; Loprinzi, Charles L.; Yothers, Greg; Sargent, Daniel J.
- Abstract
Background Current prognostic tools in colon cancer use relatively few patient characteristics. We constructed and validated clinical calculators for overall survival (OS) and time to recurrence (TTR) for stage III colon cancer and compared their performance against an existing tool (Numeracy) and American Joint Committee on Cancer (AJCC) version 7 staging. Methods Data from 15936 stage III patients accrued to phase III clinical trials since 1989 were used to construct Cox models forTTR and OS. Variables included age, sex, race, body mass index, performance status, tumor grade, tumor stage, ratio of positive lymph nodes to nodes examined, number and location of primary tumors, and adjuvant treatment (fluoropyrimidine single agent or in combination). Missing data were imputed, and final models internally validated for optimism-corrected calibration and discrimination and compared with AJCC. External validation and comparisons against Numeracy were performed using stage III patients from NSABP trial C-08. All statistical tests were two-sided. Results All variables were statistically and clinically significant for OS prediction, while age and race did not predict TTR. No meaningful interactions existed. Models for OS andTTR were well calibrated and associated with C-indices of 0.66 and 0.65, respectively, compared with C-indices of 0.58 and 0.59 for AJCC.These tools, available online, better predicted patient outcomes than Numeracy, both overall and within patient subgroups, in external validation. Conclusions The proposed ACCENT calculators are internally and externally valid, better discriminate patient risk than AJCC version 7 staging, and better predict patient outcomes than Numeracy.These tools have replaced Numeracy for online clinical use and will aid prognostication and patient/physician communication.
- Subjects
CANCER relapse; COLON cancer prognosis; TUMOR prognosis; PHYSICIAN-patient relations; LYMPH nodes
- Publication
JNCI: Journal of the National Cancer Institute, 2014, Vol 106, Issue 12, p1
- ISSN
0027-8874
- Publication type
Article
- DOI
10.1093/jnci/dju333