Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis

PLoS One. 2020 Oct 16;15(10):e0240715. doi: 10.1371/journal.pone.0240715. eCollection 2020.

Abstract

Purpose: This study aimed to determine the probability and prognostic factors of colon cancer-specific mortality (CCSM) and noncancer-specific mortality (NCSM) for patients with stage I/II colon cancer and evaluate the association of age on cause-specific mortality.

Materials and methods: From Surveillance, Epidemiology, and End Results (SEER) database, we identified 33152 patients with stage I/II colon cancer undergoing surgery between 2004 and 2011. The cumulative incidence of CCSM and NCSM was calculated, and competing risk analysis was performed to investigate prognostic factors for cause-specific mortality.

Results: In patients <50, 50-75, and >75 years of age, 5-year cumulative incidence of CCSM was 5.7%, 7.8%, and 16.1%, respectively (overall, 10.6%); 5-year cumulative incidence of NCSM was 2.2%, 7.1%, and 26.9%, respectively (overall, 13.8%). The probability of CCSM and NCSM increased with advanced age. The 5-year cumulative incidence of CCSM was higher than NCSM in patients <50 years of age, whereas lower in patients >75 years of age. The probability of CCSM and NCSM was similar in patients 50-75 years of age. Competing-risk multivariable analysis demonstrated that increasing age was a strong predictor of CCSM (per year increase, SHR 1.03,95% confidence interval [CI]: 1.03-1.04). Age was most predictive of NCSM: (per year increase, SHR 1.08, 95% CI: 1.08-1.08).

Conclusion: Age was significantly associated with an increased cumulative incidence of CCSM and NCSM of patients with stage I/II colon cancer underwent surgery. NCSM was a significant competing event and should be adequately considered when performing survival analysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Cause of Death*
  • Colonic Neoplasms / mortality*
  • Colonic Neoplasms / pathology*
  • Female
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Proportional Hazards Models
  • Risk Assessment

Grants and funding

This study was supported by the Special Financial Foundation of Fujian Provincial (No.2015-1297), Young and middle-aged backbone training project in the health system of Fujian province (2016-ZQN-26), the Startup Fund for Scientific Research, Fujian Medical University (2018QH2027) and Professor Development Foundation of Fujian Medical University (No.JS11006).