title: Survival following recurrence in stage II and III colon cancer: findings from the ACCENT data set.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Surgical Adjuvant Breast and Bowel Project Operations Office, Pittsburgh, PA 15212-5234, USA. michael.oconnell@nsabp.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Connell
authors.forename: Megan E
authors.initials: ME
authors.lastname: Campbell
authors.forename: Richard M
authors.initials: RM
authors.lastname: Goldberg
authors.forename: Axel
authors.initials: A
authors.lastname: Grothey
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Seitz
authors.forename: Jacqueline K
authors.initials: JK
authors.lastname: Benedetti
authors.forename: Thierry
authors.initials: T
authors.lastname: André
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Haller
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sargent
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models
chemical_list: D005472:Fluorouracil