Impact of prior malignancies on outcome of colorectal cancer; revisiting clinical trial eligibility criteria

Abstract

BackgroundMost clinical trials on colorectal cancer (CRC) exclude cases who have history of a prior malignancy. However, no prior research studied this history’s actual impact on the survival of CRC. In the paper, we study the effects of having a malignancy preceding CRC diagnosis on its survival outcomes.MethodsCRC patients diagnosed during 1973–2008 were reviewed using the SEER 18 database. We calculated overall survival and cancer-specific survival of subsequent CRC, and more specifically stage IV CRC, using Kaplan-Meier test and adjusted Cox models.ResultsA total 550,325 CRC patients were reviewed, of whom 31,663 had history of a prior malignancy. The most commonly reported sites of a prior malignancy were: prostate, breast, urinary bladder, lung, and endometrium. Patients with history of a prior non-leukemic malignancy or history of a prior leukemia were found to have worse overall survival (HR\u2009=\u20091.165 95%CI\u2009=\u20091.148–1.183, P\u2009<\u20090.001) and (HR\u2009=\u20091.825 95%CI\u2009=\u20091.691–1.970, P\u2009<\u20090.001), respectively. However, CRC patients with history of a prior non-leukemic malignancy showed an improved colorectal cancer-specific survival (HR\u2009=\u2009.930 95%CI\u2009=\u2009.909–.952, P\u2009<\u20090.001). Analysis of stage IV CRC patients showed that patients with history of any non-leukemic malignancy did not have a significant change in overall survival. Whereas, patients with a prior leukemia showed a worse overall survival (HR\u2009=\u20091.535, 95%CI\u2009=\u20091.303–1.809, P\u2009<\u20090.001). When analyzed separately, right CRC and left CRC showed similar survival patterns.ConclusionA prior malignancy before CRC -in general- can be associated with worse clinical survival outcomes. These worse outcomes are not observed in stage IV CRC. Considering these results when including/excluding stage IV CRC patients with prior malignancies in clinical trials may play help improve their generalizability.