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Updated: Sep 14, 2025
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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
380
Late-Stage Outcomes as Surrogates for Mortality in Cancer Screening Trials: A Systematic Review and Meta-analysis.
Matejka Rebolj1, Adam R Brentnall2, Julia Geppert3
1Centre for Cancer Screening, Prevention, and Early Detection, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
Summary
Late-stage cancer incidence shows promise as a surrogate for mortality in cancer screening trials. Further research is needed to confirm its reliability across different cancer types and conditions.
Area of Science:
- Oncology
- Clinical Trials
- Epidemiology
Background:
- Late-stage cancer incidence is a proposed surrogate outcome for cancer-specific mortality in screening trials.
- Previous meta-analyses yielded inconsistent conclusions regarding the suitability of late-stage cancer endpoints.
- This study systematically reviews the association between late-stage cancer incidence and mortality outcomes in screening trials.
Purpose of the Study:
- To investigate the correlation between the effect of cancer screening on late-stage cancer incidence and cancer-specific mortality.
- To assess the potential of late-stage cancer incidence as a surrogate outcome in cancer screening trials.
Main Methods:
- Systematic review and meta-analysis of 57 cancer screening trials (61 trial-arm comparisons).
- Analysis of the correlation between screening effects on late-stage cancer incidence and cancer-specific mortality.
- Evaluation of whether mortality effect estimates fall within the confidence intervals of late-stage incidence estimates.
Main Results:
- A combined correlation of 0.69 (95% CI: 0.47-0.84) was found between late-stage incidence and mortality outcomes across all cancers.
- Specific correlations: 0.58 for bowel, 0.79 for breast, and 0.91 for lung cancer.
- Mortality effect estimates were within late-stage incidence confidence intervals in 92% of comparisons.
Conclusions:
- Late-stage cancer incidence shows potential as a key outcome in cancer screening trials.
- Further research is required to define optimal measurement timing and address extrapolation for understudied cancer types.
- Conditions under which late-stage cancer incidence may not accurately predict mortality require clarification.
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