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

Robert J. Green, MD, MSCE; Joshua P. Metlay, MD, PhD; Kathleen Propert, ScD; Paul J. Catalano, ScD; John S. Macdonald, MD; Robert J. Mayer, MD; and Daniel G. Haller, MD
[+] Article and Author 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@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.


Ann Intern Med. 2002;136(4):261-269. doi:10.7326/0003-4819-136-4-200202190-00005
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Our study provides at least three important pieces of information. First, we found that the incidence of second primary colorectal cancer in a homogeneous cohort of intensively surveyed patients with an immediate history of stage II or stage III colon cancer was 1.5% (CI, 1.1% to 2.0%) at 5 years. Second, we have shown that despite protocol recommendations for rigorous surveillance, the incidence rate was higher in this population than in the general population and 6.8 times higher than in the National Polyp Study. Third, second primary colorectal cancer was diagnosed within a relatively short period after patients' most recent previous colonic surveillance. Our study provides important information regarding the incidence and latency period of this disease; however, we have not shown that current surveillance strategies are inadequate or that more intensive surveillance would result in decreased morbidity or mortality or would be cost-effective.

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Figure 1.
Cumulative incidence of second primary colon cancer in Intergroup 0089.
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Figure 2.
Second primary colorectal cancer and preceding surveillance.
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Summary for Patients

Second Colorectal Cancer in Patients Who Had First Colon Cancer Treated with Surgery and Chemotherapy

The summary below is from the full report titled “Surveillance for Second Primary Colorectal Cancer after Adjuvant Chemotherapy: An Analysis of Intergroup 0089.” It is in the 19 February 2002 issue of Annals of Internal Medicine (volume 136, pages 261-269). The authors are RJ Green, JP Metlay, K Propert, PJ Catalano, JS Macdonald, RJ Mayer, and DG Haller.

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