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September 21, 2011

Time to Initiation of Adjuvant Chemotherapy and Survival in Colorectal Cancer—Reply

Author Affiliations

Author Affiliations: Departments of Oncology (Dr Biagi) (jim.biagi@krcc.on.ca) and Community Health and Epidemiology (Dr King) and Division of Cancer Care and Epidemiology (Dr Booth), Queen's University, Kingston, Ontario, Canada.

JAMA. 2011;306(11):1199-1200. doi:10.1001/jama.2011.1321

In Reply: We disagree with a number of statements in the letter by Dr Sargent and colleagues. First, we disagree that a hazard ratio for overall survival of 1.14 is not meaningful. This hazard ratio represents an effect per 4 weeks that is of a magnitude comparable with new adjuvant systemic therapies. Second, they assert that the analysis was dominated by 1 large study; as we described, the overall and disease-free survival results were maintained after sequential exclusion of each of the 3 largest-weighted trials. Furthermore, our analysis demonstrated consistency in results and effect sizes across overall survival, disease-free survival, and cancer-specific survival and are consistent with other published results in this field.1