Analyzing the Long-Term Survival of Colon and Rectal Cancer Patients Using Non-Mixture Cure Rate Model
Abstract
BACKGROUND: Colorectal cancer is the most common cause of cancer mortality in Iran. There are differences in the etiology, clinical behavior and pathological features in cancer of the colon versus the rectum. The aim of this study was to evaluate the factors related to survival and cure probability of patients with colon and rectal cancer using a semi-parametric non-mixture cure rate model.
METHODS: This retrospective cohort study was conducted on 311 patients, with colorectal cancer. Data of all patients with colon and rectum malignances who underwent the first treatment in Omid Hospital, Mashhad, between 2006 and 2011 were gathered through medical records. Patients were followed-up for 9 years until September 2020. Semi-parametric non-mixture cure model was implemented using miCoPTCM package in the R software.
RESULTS: The mean survival time was 2973.94 days (95% confidence interval [CI], 2694.96 to 3252.93). The 5-year survival rates for colon and rectal cancer patients were 0.54 (%95 CI:(0.45, 0.61)) and 0.57 (%95 CI:(0.48,0.65)), respectively. The proportion of cured patients for colon cancer was 44.0%, and for rectal cancer was 40.0%.Age and stage of the disease were determined as factors related to survival and cure fraction of both colon and rectal cancers. In addition, ethnicity and type of treatment were distinguished as factors related to survival and cure fraction of rectal cancer. While the history of drug abuse only increased the hazard of death in colon cancer patients; overweight as a protective variable increased the survival and cure fraction of rectal cancer patients.
CONCLUSION: Because the factors associated with colorectal cancer are not necessarily equal to the risk factors for colon and rectal cancer, it is recommended to obtain more accurate and valid results in the survival analysis of colorectal cancer patients, the colon and rectum should be considered separately. It is also appropriate to use cure rate models when there is a cure fraction in the data.
References
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A competing risks cure frailty model: An
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on survival in colorectal cancer. Journal of
gastrointestinal oncology. 2015 Dec;6(6):605.
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SV, Khodakarim S. Mismeasured Covariate in
the Long-Term Survival of Colorectal Cancer.
Galen Medical Journal. 2019 Jul 8;8:1413.
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of surgical oncology. 2017 Apr 1;24(4):1093-9.
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IIB/C (T4N0) compared to stage IIIA (T1-2
N1, T1N2a) colon cancer persists even after
adjusting for adequate lymph nodes retrieved
and receipt of adjuvant chemotherapy. BMC
cancer. 2016 Dec 1;16(1):460.
30. AzizmohammadLooha M, Zarean E,
Pourhoseingholi MA, Hosseini SV, Azimi
T, Khodakarim S. Analyzing the long-term
survival of patients with colorectal cancer:
a study using parametric non-mixture cure
rate models. International Journal of Cancer
Management. 2018 Sep 30;11(9).
31. Sabouri S, Esmaily H, Shahid Sales S, Emadi
M. Determining related factors to survival of
colorectal cancer patients using cox regression.
medical journal of mashhad university of
medical sciences. 2018;61(4):1083-92.
32. Gohari MR, Biglarian A, Bakhshi E,
Pourhoseingholi MA. Use of an artificial neural
network to determine prognostic factors in
colorectal cancer patients. Asian Pac J Cancer
Prev. 2011 Jan 1;12(6):1469-72.
33. Parsaee R, Fekri N, SHAHID SS, AFZAL
AM, SHAARBAF EE, Esmaeily H. Prognostic
factors in the survival rate of colorectal cancer
patients. Journal of North Khorasan University
2014;7(1):45-53
34. Sanoff HK, Carpenter WR, Stürmer T,
Goldberg RM, Martin CF, Fine JP, McCleary
NJ, Meyerhardt JA, Niland J, Kahn KL,
Schymura MJ. Effect of adjuvant chemotherapy
on survival of patients with stage III colon
cancer diagnosed after age 75 years. Journal of
Clinical Oncology. 2012 Jul 20;30(21):2624.
35. Stoffel EM, Murphy CC. Epidemiology
and mechanisms of the increasing incidence
of colon and rectal cancers in young adults.
Gastroenterology. 2020 Jan 1;158(2):341-53.
36. Berger MD, Yang D, Sunakawa Y, Zhang
W, Ning Y, Matsusaka S, Okazaki S, Miyamoto
Y, Suenaga M, Schirripa M, Lenz AM. Impact
of sex, age, and ethnicity/race on the survival
of patients with rectal cancer in the United
States from 1988 to 2012. Oncotarget. 2016
Aug 16;7(33):53668.
1. GBD 2015 Risk Factors Collaborators.
Global, regional, and na¬tional comparative risk
assessment of 79 behavioural, environ¬mental
and occupational, and metabolic risks or clusters
of risks, 1990-2015: a systematic analysis for
the Global Burden of Disease Study 2015.
Lancet 2016;388:1659-1724.
2. Simonian M, Khosravi S, Mortazavi D,
Bagheri H, Salehi R, Hassanzadeh A, Mosallaei
M. Environmental Risk Factors Associated
with Sporadic Colorectal Cancer in Isfahan,
Iran. Middle East Journal of Cancer. 2018 Oct
1;9(4):318-22.
3. Keum N, Giovannucci E. Global burden
of colorectal cancer: emerging trends, risk
factors and prevention strategies. Nature
reviews Gastroenterology &hepatology. 2019
Dec;16(12):713-32.
4. Bray F, Ferlay J, Soerjomataram I, Siegel
RL, Torre LA, Jemal A. Global cancer statistics
2018: GLOBOCAN estimates of incidence
and mortality worldwide for 36 cancers in 185
countries. CA: a cancer journal for clinicians.
2018 Nov;68(6):394-424.
5. Salimzadeh H, Sauvaget C, Alamdari RA.
Knowledge, attitude, and practice of Iranian
physicians towards colorectal cancer screening.
Arch Dig Disord. 2018; 2 (1): 1-6 2 Arch Dig
Disord 2018 Volume 2 Issue. 2018;1.
6. Looha MA, Pourhoseingholi MA, Hosseini
SV, Khodakarim S. Mismeasured Covariate in
the Long-Term Survival of Colorectal Cancer.
Galen Medical Journal. 2019 Jul 8;8:1413.
7. Stevenson G. Colorectal cancer screening of
high-risk individuals. Canadian Association of
Radiologists Journal. 2001 Feb 1;52(1):17.
8. Agah SH, Ghasemi AB, Rezaei MA,
Ashayeri N, Fereshtehnejad SM, Mohammad
Sadeghi H. Frequency determination of polyps
and colorectal tumors among patients who
underwent colonoscopy in Shariati hospital.
Razi Journal of Medical Sciences. 2009 Jan
15;15:13-8.
9. Ghavami V, Mahmoudi M, Foroushani
AR, Baghishani H, Shandiz FH, Yaseri M.
Long-Term Disease-Free Survival of Non-
Metastatic Breast Cancer Patients in Iran: A
Survival Model with Competing Risks Taking
Cure Fraction and Frailty into Account. Asian
Pacific journal of cancer prevention: APJCP.
2017;18(10):2825.
10. Vijan S, Hwang EW, Hofer TP, Hayward
RA. Which colon cancer screening test?
A comparison of costs, effectiveness, and
compliance. The American journal of medicine.
2001 Dec 1;111(8):593-601.
11. Kapiteijn E, Liefers GJ, Los LC, Klein
Kranenbarg E, Hermans J, Tollenaar RA,
Moriya Y, Van De Velde CJ, Van Krieken JH.
Mechanisms of oncogenesis in colon versus
rectal cancer. The Journal of pathology. 2001
Sep;195(2):171-8.
12. Corbière F, Commenges D, Taylor JM, Joly
P. A penalized likelihood approach for mixture
cure models. Statistics in medicine. 2009 Feb
10;28(3):510-24.
13. Amico M, Van Keilegom I. Cure models in
survival analysis. Annual Review of Statistics
and Its Application. 2018 Mar 7;5:311-42.
14. Maller, R. A., Zhou, S: Survival analysis
with long term survivors. Wiley:New York.
1996.
15. Othus M, Barlogie B, LeBlanc ML, Crowley
JJ. Cure models as a useful statistical tool fornalyzing survival. Clinical Cancer Research.
2012 Jul 15;18(14):3731-6.
16. D. S. Ming-Hui Chen, Joseph G. Ibrahim,
“A new Bayesian model for survival data with
a surviving fraction”, Journal of the American
Statistical Association, vol. 94, no. 447, pp.
909–919, 1999.
17. Edge SB, Compton CC. The American
Joint Committee on Cancer: the 7th edition
of the AJCC cancer staging manual and the
future of TNM. Annals of surgical oncology.
2010;17(6):1471-4.
18. Vahidpour M. Cure rate models (Doctoral
dissertation, ÉcolePolytechnique de
Montréal);2016.
19. Martinez EZ, Achcar JA, Jácome AA,
Santos JS. Mixture and non-mixture cure
fraction models based on the generalized
modified Weibull distribution with an
application to gastric cancer data. Computer
methods and programs in biomedicine. 2013
Dec 1;112(3):343-55.
20. Ghavami V, Mahmoudi M, Foroushani
AR, Baghishani H, Yaseri M, Shandiz FH.
A competing risks cure frailty model: An
application to relapse-free survival of breast
cancer patients. Pakistan Journal of Statistics
and Operation Research. 2021 Sep 2:591-605.
21. Asano J, Hirakawa A, Hamada C. Assessing
the prediction accuracy of cure in the Cox
proportional hazards cure model: an application
to breast cancer data. Pharmaceutical statistics.
2014 Nov;13(6):357-63.
22. Aykan NF. Red meat and colorectal cancer.
Oncology reviews. 2015 Feb 10;9(1).
23. van der Sijp MP, Bastiaannet E, Mesker WE,
van der Geest LG, Breugom AJ, Steup WH,
Marinelli AW, Tseng LN, Tollenaar RA, van
de Velde CJ, Dekker JW. Differences between
colon and rectal cancer in complications, short-
term survival and recurrences. International
Journal of Colorectal Disease. 2016 Oct
1;31(10):1683-91.
24. Morrison DS, Batty GD, Kivimaki M, Smith
GD, Marmot M, Shipley M. Risk factors for
colonic and rectal cancer mortality: evidence
from 40 years’ follow-up in the Whitehall I
study. J Epidemiol Community Health. 2011
Nov 1;65(11):1053-8.
25. van Eeghen EE, Bakker SD, van Bochove
A, Loffeld RJ. Impact of age and comorbidity
on survival in colorectal cancer. Journal of
gastrointestinal oncology. 2015 Dec;6(6):605.
26. Looha MA, Pourhoseingholi MA, Hosseini
SV, Khodakarim S. Mismeasured Covariate in
the Long-Term Survival of Colorectal Cancer.
Galen Medical Journal. 2019 Jul 8;8:1413.
27. Li M, Li JY, Zhao AL, Gu J. Colorectal
cancer or colon and rectal cancer?. Oncology.
2007;73(1-2):52-7.
28. Liska D, Stocchi L, Karagkounis G, Elagili
F, Dietz DW, Kalady MF, Kessler H, Remzi FH,
Church J. Incidence, patterns, and predictors of
locoregional recurrence in colon cancer. Annals
of surgical oncology. 2017 Apr 1;24(4):1093-9.
29. Chu QD, Zhou M, Medeiros KL, Peddi P,Kavanaugh M, Wu XC. Poor survival in stage
IIB/C (T4N0) compared to stage IIIA (T1-2
N1, T1N2a) colon cancer persists even after
adjusting for adequate lymph nodes retrieved
and receipt of adjuvant chemotherapy. BMC
cancer. 2016 Dec 1;16(1):460.
30. AzizmohammadLooha M, Zarean E,
Pourhoseingholi MA, Hosseini SV, Azimi
T, Khodakarim S. Analyzing the long-term
survival of patients with colorectal cancer:
a study using parametric non-mixture cure
rate models. International Journal of Cancer
Management. 2018 Sep 30;11(9).
31. Sabouri S, Esmaily H, Shahid Sales S, Emadi
M. Determining related factors to survival of
colorectal cancer patients using cox regression.
medical journal of mashhad university of
medical sciences. 2018;61(4):1083-92.
32. Gohari MR, Biglarian A, Bakhshi E,
Pourhoseingholi MA. Use of an artificial neural
network to determine prognostic factors in
colorectal cancer patients. Asian Pac J Cancer
Prev. 2011 Jan 1;12(6):1469-72.
33. Parsaee R, Fekri N, SHAHID SS, AFZAL
AM, SHAARBAF EE, Esmaeily H. Prognostic
factors in the survival rate of colorectal cancer
patients. Journal of North Khorasan University
2014;7(1):45-53
34. Sanoff HK, Carpenter WR, Stürmer T,
Goldberg RM, Martin CF, Fine JP, McCleary
NJ, Meyerhardt JA, Niland J, Kahn KL,
Schymura MJ. Effect of adjuvant chemotherapy
on survival of patients with stage III colon
cancer diagnosed after age 75 years. Journal of
Clinical Oncology. 2012 Jul 20;30(21):2624.
35. Stoffel EM, Murphy CC. Epidemiology
and mechanisms of the increasing incidence
of colon and rectal cancers in young adults.
Gastroenterology. 2020 Jan 1;158(2):341-53.
36. Berger MD, Yang D, Sunakawa Y, Zhang
W, Ning Y, Matsusaka S, Okazaki S, Miyamoto
Y, Suenaga M, Schirripa M, Lenz AM. Impact
of sex, age, and ethnicity/race on the survival
of patients with rectal cancer in the United
States from 1988 to 2012. Oncotarget. 2016
Aug 16;7(33):53668.
| Files | ||
| Issue | Vol 8 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jbe.v8i3.12302 | |
| Keywords | ||
| Survival Analysis, Semi-Parametric Non-Mixture Cure Model, Colorectal Neoplasm, Cure Fraction | ||
| Rights and permissions | |
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How to Cite
1.
sadeghi reihaneh. Analyzing the Long-Term Survival of Colon and Rectal Cancer Patients Using Non-Mixture Cure Rate Model. JBE. 2022;8(3):269-280.
