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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Estimating Population-Based Recurrence Rates of Colorectal Cancer over Time in the United States

Natalia Kunst, Fernando Alarid-Escudero, Eline Aas, Veerle M.H. Coupé, Deborah Schrag and Karen M. Kuntz
Natalia Kunst
1Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
2Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut.
3Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
4LINK Medical Research, Oslo, Norway.
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  • ORCID record for Natalia Kunst
  • For correspondence: natalia.kunst@medisin.uio.no natalia.kunst@yale.edu
Fernando Alarid-Escudero
5Division of Public Administration, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Aguascalientes, Mexico.
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Eline Aas
1Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Veerle M.H. Coupé
3Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
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Deborah Schrag
6Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Karen M. Kuntz
7Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota.
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DOI: 10.1158/1055-9965.EPI-20-0490 Published December 2020
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Abstract

Background: Population-based metastatic recurrence rates for patients diagnosed with nonmetastatic colorectal cancer cannot be estimated directly from population-based cancer registries because recurrence information is not reported. We derived population-based colorectal cancer recurrence rates using disease-specific survival data based on our understanding of the colorectal cancer recurrence-death process.

Methods: We used a statistical continuous-time multistate survival model to derive population-based annual colorectal cancer recurrence rates from 6 months to 10 years after colorectal cancer diagnosis using relative survival data from the Surveillance, Epidemiology, and End Results Program. The model was based on the assumption that, after 6 months of diagnosis, all colorectal cancer–related deaths occur only in patients who experience a metastatic recurrence first, and that the annual colorectal cancer–specific death rate among patients with recurrence was the same as in those diagnosed with de novo metastatic disease. We allowed recurrence rates to vary by post-diagnosis time, age, stage, and location for two diagnostic time periods.

Results: In patients diagnosed in 1975–1984, annual recurrence rates 6 months to 5 years after diagnosis ranged from 0.054 to 0.060 in stage II colon cancer, 0.094 to 0.105 in stage II rectal cancer, and 0.146 to 0.177 in stage III colorectal cancer, depending on age. We found a statistically significant decrease in colorectal cancer recurrence among patients diagnosed in 1994–2003 compared with those diagnosed in 1975–1984 for 6 months to 5 years after diagnosis (hazard ratios between 0.43 and 0.70).

Conclusions: We derived population-based annual recurrence rates for up to 10 years after diagnosis using relative survival data.

Impact: Our estimates can be used in decision-analytic models to facilitate analyses of colorectal cancer interventions that are more generalizable.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Cancer Epidemiol Biomarkers Prev 2020;29:2710–8

  • Received March 30, 2020.
  • Revision received June 1, 2020.
  • Accepted September 26, 2020.
  • Published first September 30, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 29 (12)
December 2020
Volume 29, Issue 12
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Estimating Population-Based Recurrence Rates of Colorectal Cancer over Time in the United States
Natalia Kunst, Fernando Alarid-Escudero, Eline Aas, Veerle M.H. Coupé, Deborah Schrag and Karen M. Kuntz
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2710-2718; DOI: 10.1158/1055-9965.EPI-20-0490

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Estimating Population-Based Recurrence Rates of Colorectal Cancer over Time in the United States
Natalia Kunst, Fernando Alarid-Escudero, Eline Aas, Veerle M.H. Coupé, Deborah Schrag and Karen M. Kuntz
Cancer Epidemiol Biomarkers Prev December 1 2020 (29) (12) 2710-2718; DOI: 10.1158/1055-9965.EPI-20-0490
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