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Survival Following Recurrence in Stage II and III Colon Cancer: Findings From the ACCENT Data Set

Michael J. O'Connell, Megan E. Campbell, Richard M. Goldberg, Axel Grothey, Jean-François Seitz, Jacqueline K. Benedetti, Thierry André, Daniel G. Haller, Daniel J. Sargent

From the National Surgical Adjuvant Breast and Bowel Project Operations Office, Pittsburgh; Eastern Cooperative Oncology Group, Philadelphia, PA; Mayo Clinic, Rochester, MN; Cancer and Leukemia Group B, Chicago, IL; Federation Francophone de Cancerologie Digestive, University of the Mediterranean, Marseilles; Groupe Cooperateur Multidisciplinaire en Oncologie, Paris, France; and Southwest Oncology Group Statistical Center, Seattle, WA

Corresponding author: Michael J O'Connell, MD, NSABP Foundation, Inc, Four Allegheny Center, 5th Floor, Pittsburgh, PA 15212-5234; e-mail: michael.oconnell{at}nsabp.org

Purpose: This study was undertaken to examine five possible prognostic factors in patients with recurrent stage II and III colon cancer: time from randomization on an adjuvant therapy clinical trial to tumor recurrence (< 1 year, 1 to 2 years, 2 to 3 years, 3 to 4 years, > 4 years), initial stage (II v III), initial adjuvant treatment (fluorouracil [FU]-based v surgery alone), the era in which the patient entered an adjuvant therapy clinical trial (1978 to 1985, 1986 to 1992, 1993 to 1999), and patient age at recurrence.

Methods: The Adjuvant Colon Cancer End Points (ACCENT) data set was analyzed using univariate and multivariate Cox proportional hazards models, stratified by study.

Results: 5,722 (32.9%) of 17,381 patients experienced recurrence. Median survival following recurrence was 13.3 months. Time from randomization to recurrence was highly prognostic of survival following recurrence (P < .0001). Longer survival following recurrence was seen in patients with initial stage II versus III disease (P < .0001; 14.3% 6-year overall survival after recurrence in initial stage II patients), patients entered more recently onto trials (P < .0001), and patients initially treated with surgery alone versus FU adjuvant treatment (P = .0005). All relationships were maintained in multivariate models.

Conclusion: Time from initial treatment to recurrence and initial stage are important prognostic factors in patients with recurrent colon cancer. Survival following recurrence increased modestly from 1978 to 1999. Patients who had a recurrence following adjuvant therapy had poorer prognosis than those who progressed after surgery alone. These prognostic factors may be useful for clinical trial design and treatment decisions in patients with recurrent colon cancer.

Supported in part by Public Health Service Grants No. U10CA-12027, U10CA-69974, U10CA-37377 and U10CA-69651 from the National Cancer Institute, Department of Health and Human Services.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.