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Risk prediction equations for survival in colorectal cancer
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Researchers have developed risk prediction equations to estimate survival for patients with colorectal cancer. Julia Hippisley-Cox and Carol Coupland (University of Nottingham, UK) obtained data for 44 145 individuals aged 15–99 years with colorectal cancer from the QResearch database, which provides detailed information about patients from UK general practices and is linked to the national cancer registry. They created a risk calculator for allcause mortality (primary outcome) and cancer-specific mortality (secondary outcome) using information from both databases. “There is age, sex, grade and stage of tumour, and treatment [and] factors such as smoking status, diabetes, heart disease, prescriptions, and laboratory tests”, explained Hippisley-Cox. “The model also takes into account time since diagnosis, so the prognosis can be updated on a yearly basis”.
The researchers found that improved survival in women was associated with colorectal cancer surgery (adjusted hazard ratio 0·47 [95% CI 0·44–0·51]), family history of bowel cancer (0·58 [0·46–0·74]), and prescriptions for statins (0·72 [0·66–0·78]) and aspirin (0·86 [0·77–0·96]) at diagnosis, among other factors. The results were broadly similar for men. Factors associated with worse survival included deprivation, heavy smoking, and type 2 diabetes. The predicted risks corresponded to the observed risks. The equations were tested on validation cohorts drawn from the QResearch database (n=15 214) and the national cancer registry (n=437 821). “Both external validation cohorts showed that the risk prediction equations had good discrimination”, said Hippisley-Cox. She added that risk estimates currently tend to be based on single factors, whereas a multivariate
model can provide a personalised assessment. “A young person with colorectal cancer with a good overall outlook may be more inclined to go for more aggressive treatment than someone who has a lot of other problems that are likely to affect their overall survival”, said Hippisley-Cox. The patients in the study were diagnosed with colorectal cancer from 1998 to 2014. Robert Glynne-Jones (Mount Vernon Hospital, Middlesex, UK) cautioned that substantial advances in surgery in the past decade could affect the accuracy of the risk prediction equations. He welcomed the scale of the study and noted that the results also offer useful information on the benefits of statins and aspirin. “Eventually we are going to get some idea of what a good preventative looks like for colorectal cancer”, he added.
Tony Craddock/Science Photo Library
Risk prediction equations for survival in colorectal cancer
Lancet Oncol 2017 Published Online June 22, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30502-8 For the study by Hippisley-Cox and Coupland see BMJ 2017; 357: j2497.
Talha Khan Burki
www.thelancet.com/oncology Published online June 22, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30502-8
1
Researchers have developed risk prediction equations to estimate survival for patients with colorectal cancer. Julia Hippisley-Cox and Carol Coupland (University of Nottingham, UK) obtained data for 44 145 individuals aged 15–99 years with colorectal cancer from the QResearch database, which provides detailed information about patients from UK general practices and is linked to the national cancer registry. They created a risk calculator for allcause mortality (primary outcome) and cancer-specific mortality (secondary outcome) using information from both databases. “There is age, sex, grade and stage of tumour, and treatment [and] factors such as smoking status, diabetes, heart disease, prescriptions, and laboratory tests”, explained Hippisley-Cox. “The model also takes into account time since diagnosis, so the prognosis can be updated on a yearly basis”.
The researchers found that improved survival in women was associated with colorectal cancer surgery (adjusted hazard ratio 0·47 [95% CI 0·44–0·51]), family history of bowel cancer (0·58 [0·46–0·74]), and prescriptions for statins (0·72 [0·66–0·78]) and aspirin (0·86 [0·77–0·96]) at diagnosis, among other factors. The results were broadly similar for men. Factors associated with worse survival included deprivation, heavy smoking, and type 2 diabetes. The predicted risks corresponded to the observed risks. The equations were tested on validation cohorts drawn from the QResearch database (n=15 214) and the national cancer registry (n=437 821). “Both external validation cohorts showed that the risk prediction equations had good discrimination”, said Hippisley-Cox. She added that risk estimates currently tend to be based on single factors, whereas a multivariate
model can provide a personalised assessment. “A young person with colorectal cancer with a good overall outlook may be more inclined to go for more aggressive treatment than someone who has a lot of other problems that are likely to affect their overall survival”, said Hippisley-Cox. The patients in the study were diagnosed with colorectal cancer from 1998 to 2014. Robert Glynne-Jones (Mount Vernon Hospital, Middlesex, UK) cautioned that substantial advances in surgery in the past decade could affect the accuracy of the risk prediction equations. He welcomed the scale of the study and noted that the results also offer useful information on the benefits of statins and aspirin. “Eventually we are going to get some idea of what a good preventative looks like for colorectal cancer”, he added.
Tony Craddock/Science Photo Library
Risk prediction equations for survival in colorectal cancer
Lancet Oncol 2017 Published Online June 22, 2017 http://dx.doi.org/10.1016/ S1470-2045(17)30502-8 For the study by Hippisley-Cox and Coupland see BMJ 2017; 357: j2497.
Talha Khan Burki
www.thelancet.com/oncology Published online June 22, 2017 http://dx.doi.org/10.1016/S1470-2045(17)30502-8
1