Surveillance for Second Primary Colorectal Cancer after Adjuvant Chemotherapy: An Analysis of Intergroup 0089

19 February 2002 | Volume 136 Issue 4 | Pages 261-269

Background: The incidence of second primary colorectal cancer in patients with a history of colon cancer, compared with patients with a history of adenomatous polyps, is unknown. It is unclear whether guidelines for colonoscopy screening in patients with polyps are appropriate for patients with previous colon cancer.

Objective: To determine the incidence of second primary colorectal cancer after treatment for localized colon cancer and to compare this incidence with that of first primary colorectal cancer in both the general population and high-risk patients.

Design: Historical cohort study.

Setting: An international, multi-institutional trial of adjuvant 5-fluorouracil-based chemotherapy for localized colon cancer.

Patients: 3278 patients with resected stage II and stage III colon cancer.

Measurements: Occurrence of endoscopic or radiologic colon surveillance and incidence of second primary colorectal cancer.

Results: Forty-two cases of second primary invasive colon cancer were found over 15 345 person-years of follow-up, yielding an incidence rate of 274 per 100 000 person-years (95% CI, 196 to 369 per 100 000 person-years) and a cumulative incidence of 1.5% (CI, 1.1% to 2.0%) at 5 years. This rate was compared with rates of first colon cancer in two reference groups: the general population and patients who had undergone frequent colonoscopy and polypectomy because of a history of adenomatous polyps; standardized incidence ratios were 1.6 (CI, 1.2 to 2.2) and 6.8 (CI, 2.7 to 22.0), respectively.

Conclusion: The incidence of second primary colorectal cancer remains high despite intensive surveillance strategies.

Editors' Notes Context Patients who have had colorectal cancer can develop second primary colorectal cancer. The American Cancer Society recommends that surveillance colonoscopy be performed 1 year after surgery, then every 3 to 5 years if results are negative. This surveillance strategy is unproven. Contribution This study documented an incidence rate of 274 cases of second primary colon cancer per 100 000 person-years after surgery with curative intent and 5-fluorouracil-based chemotherapy. The incidence of second cancer was higher than the incidence of first colorectal cancer in the general population, despite surveillance. Cautions This study suggests that surveillance may need to be more vigilant than currently recommended. However, more data are needed to decide how often to do surveillance colonoscopy. –The Editors

 

Author and Article Information

From University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Dana-Farber Cancer Institute, Boston, Massachusetts; and St. Vincent's Comprehensive Cancer Center, New York, New York.

Disclaimer: The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Acknowledgment: The authors thank James Lewis, MD, MSCE, for thoughtful comments and review of the manuscript. This study was coordinated by the Eastern Cooperative Oncology Group (Robert L. Comis, MD, Chair).

Grant Support: In part by Public Health Service grants CA15488, CA23318, CA31946, CA32102, CA66636, and CA21115 from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services. Additional funding was received by Dr. Green (NCI T32 CA-09679), Dr. Metlay (Research Career Development Award in Health Services Research and Development from the Department of Veterans Affairs), Dr. Propert (NCI P30-CA-16520-25), and Dr. Mayer (NCA 5U10 CA-32291-19).

Requests for Single Reprints: Daniel G. Haller, MD, 16 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104-4283; e-mail, haller.daniel{at}uphs.upenn.edu.

Current Author Addresses: Dr. Green: The Helen and Harry Gray Cancer Institute, 1309 North Flagler Drive, West Palm Beach, FL 33401.

Drs. Metlay and Propert: Center for Clinical Epidemiology and Biostatistics, 712 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.

Drs. Catalano and Mayer: Eastern Cooperative Oncology Group Statistical Center, Department of Biostatistical Science, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Dr. Macdonald: St. Vincent's Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011.

Dr. Haller: 16 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104-4283.

Author Contributions: Conception and design: R.J. Green, J.P. Metlay, K. Propert, J.S. Macdonald, D.G. Haller.

Analysis and interpretation of the data: R.J. Green, J.P. Metlay, K. Propert, D.G. Haller.

Drafting of the article: R.J. Green, J.P. Metlay, K. Propert, R.J. Mayer, D.G. Haller.

Critical revision of the article for important intellectual content: R.J. Green, J.P. Metlay, K. Propert, R.J. Mayer, D.G. Haller.

Final approval of the article: R.J. Green, K. Propert, J.S. Macdonald, R.J. Mayer, D.G. Haller.

Provision of study materials or patients: P.J. Catalano, R.J. Mayer, D.G. Haller.

Statistical expertise: R.J. Green, K. Propert, P.J. Catalano.

Obtaining of funding: R.J. Green, D.G. Haller.

Collection and assembly of data: R.J. Green, P.J. Catalano, D.G. Haller.