{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T02:22:08Z","timestamp":1790130128259,"version":"4.0.1"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"ARCAD Foundation"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Med Oncol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Benchmarking international cancer survival differences is necessary to evaluate and improve healthcare systems. Our aim was to assess the potential regional differences in outcomes among patients with metastatic colorectal cancer (mCRC) participating in international randomized clinical trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Countries were grouped into 11 regions according to the World Health Organization and the EUROCARE model. Meta-analyses based on individual patient data were used to synthesize data across studies and regions and to conduct comparisons for outcomes in a two-stage random-effects model after adjusting for age, sex, performance status, and time period. We used mCRC patients enrolled in the first-line RCTs from the ARCAD database, which provided enrolling country information. There were 21,509 patients in 27 RCTs included across the 11 regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Main outcomes were overall survival (OS) and progression-free survival (PFS). Compared with other regions, patients from the United Kingdom (UK) and Ireland were proportionaly over-represented, older, with higher performance status, more frequently male, and more commonly not treated with biological therapies. Cohorts from central Europe and the United States (USA) had significantly longer OS compared with those from UK and Ireland ( p\u2009=\u20090.0034 and p\u2009&lt;\u20090.001, respectively), with median difference of 3\u20134\u2009months. The survival deficits in the UK and Ireland cohorts were, at most, 15% at 1\u2009year. No evidence of a regional disparity was observed for PFS. Among those treated without biological therapies, patients from the UK and Ireland had shorter OS than central Europe patients ( p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Significant international disparities in the OS of cohorts of mCRC patients enrolled in RCTs were found. Survival of mCRC patients included in RCTs was consistently lower in the UK and Ireland regions than in central Europe, southern Europe, and the USA, potentially attributed to greater overall population representation, delayed diagnosis, and reduced availability of therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17588359211020547","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T09:48:54Z","timestamp":1625046534000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of geography on prognostic outcomes of 21,509 patients with metastatic colorectal cancer enrolled in clinical trials: an ARCAD database analysis"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3242-9664","authenticated-orcid":false,"given":"Jun","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaheenah","family":"Dawood","sequence":"additional","affiliation":[{"name":"Mediclinic City Hospital: North Wing, Dubai Health Care City, Dubai UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Meyers","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Zalcberg","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Seymour","sequence":"additional","affiliation":[{"name":"NIHR Clinical Research Network, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Maughan","sequence":"additional","affiliation":[{"name":"CRUK\/MRC Oxford Institute for Radiation Oncology, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Saltz","sequence":"additional","affiliation":[{"name":"Memory Sloan Kettering Cancer Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Van Cutsem","sequence":"additional","affiliation":[{"name":"Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Venook","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of California San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Joachim","family":"Schmoll","sequence":"additional","affiliation":[{"name":"Klinik fur Innere Med IV, University Clinic Halle, Saale, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Oncology, West Virginia University, Morgantown, WV, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Hoff","sequence":"additional","affiliation":[{"name":"Centro de Oncologia de Brasilia do Sirio Libanes: Unidade Lago Sul, Siro Libanes, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Randolph","family":"Hecht","sequence":"additional","affiliation":[{"name":"Ronald Reagan UCLA Medical Center, UCLS Medical Center, Santa Monica, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute, Duke University, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Punt","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Diaz Rubio","sequence":"additional","affiliation":[{"name":"Department Oncology, Hospital Cl\u00ednico San Carlos, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Koopman","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Cremolini","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Heinemann","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Comprehensive Cancer Center, University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Tournigard","sequence":"additional","affiliation":[{"name":"Hopital Henri Mondor, Creteil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Bokemeyer","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Director of Yale Cancer Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niall","family":"Tebbutt","sequence":"additional","affiliation":[{"name":"Sydney Medical School, University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Souglakos","sequence":"additional","affiliation":[{"name":"University of Crete, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Yves","family":"Doulliard","sequence":"additional","affiliation":[{"name":"University of Nantes Medical School, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fairooz","family":"Kabbinavar","sequence":"additional","affiliation":[{"name":"UCLA Medical Center, Santa Monica, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoist","family":"Chibaudel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimery","family":"de Gramont","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Grothey","sequence":"additional","affiliation":[{"name":"West Cancer Center, Germantown, TN, 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