Outcome of Combined Hepatocellular and Cholangiocarcinoma of the Liver

Background. The objective of this study was to examine the epidemiology, natural history, and prognostic factors of combined hepatocellular and cholangiocarcinoma (cHCC-CC) using population-based registry.Methods. The Surveillance, Epidemiology, and End Results Program database (1973–2004) was used to identify cases of cHCC-CC. Multivariable logistic regression was used to evaluate factors associated with cancer-directed surgery (CDS). The influence of CDS on cancer specific survival was evaluated using Kaplan-Meier curves and Cox proportional hazards modeling.Results. A total of 380 cases of cHCC-CC were identified, which account for approximately 0.87% of primary liver tumors. Of all patients, 69.8% of patients had regional or distant stage; 65.6% of patients had poorly or undifferentiated histology. Only 44.9% of patients with localized disease, received CDS. By logistic regression analysis, being widowed, advanced stage, and earlier diagnosis year were associated with lower rate of utilization of CDS. In multivariate analysis, tumor stage, receipt of CDS, and recent year of diagnosis were found to be significant predictors for cancer-specific survival.Conclusions. Patients with localized cHCC-CC who are selected for CDS were strongly associated with improved survival. However, many patients with localized tumors did not receive potentially curative cancer-directed surgery. Further study is warranted to address the barriers to the delivery of appropriate care to these patients.

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The Natural History and Outcomes of the Patients with Carcinosarcoma Involving Kidney and Renal Pelvis

Advances in Urology ◽

10.1155/2011/693964 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Jue Wang ◽

Fen Wei Wang ◽

Anne Kessinger

Keyword(s):

Natural History ◽

Renal Pelvis ◽

Histological Grade ◽

Tumor Stage ◽

Population Based ◽

Age At Diagnosis ◽

Cancer Specific Survival ◽

Entire Cohort ◽

Undifferentiated Histology ◽

Almost All

Background. The objective of this paper was to examine the epidemiology, natural history, and prognostic factors of carcinosarcoma of the kidney and renal pelvis (CSKP) using population-based registry.Patients and Methods. Forty-three patients with CSKP, diagnosed between January 1973 and December 2007, were identified from the national Surveillance, Epidemiology, and End Results (SEER) database and reviewed.Results. 79% of all patients with known SEER stage were classified as having regional or distant stage; almost all the patients with known histology grade had poorly or undifferentiated histology. The median cancer specific survival was 6 months (95% CI 4–9). The 1-year cancer-specific survival rate for entire cohort was 30.2%. There were no differences in terms of age at diagnosis, histological grade, tumor stage on presentation, and frequency of nephrectomy between carcinosarcoma of kidney (CSK) or renal pelvis (CSP). In multivariate analysis, age at diagnosis, tumor stage, and year of diagnosis were found to be significant predictors for cancer-specific survival.Conclusion. CSKP commonly presented as high-grade, advanced stage disease, and was associated with a poor prognosis regardless of location.

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The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab157 ◽

2021 ◽

Author(s):

Joshua R Ehrlich ◽

Bonnielin K Swenor ◽

Yunshu Zhou ◽

Kenneth M Langa

Keyword(s):

Visual Acuity ◽

Logistic Regression ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vision Impairment ◽

Logistic Regression Models ◽

Cox Proportional Hazards Models ◽

Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

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Utilization and outcomes of primary tumor surgery for stage IV colon cancer in the United States: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3542 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3542-3542

Author(s):

Yvonne Sada ◽

Zhigang Duan ◽

Hashem El-Serag ◽

Jessica Davila

Keyword(s):

Colon Cancer ◽

Logistic Regression ◽

Primary Tumor ◽

Proportional Hazards ◽

Stage Iv ◽

The United States ◽

Cox Proportional Hazards ◽

Tumor Surgery ◽

Cancer Specific Survival ◽

Co Morbidity

3542 Background: Stage IV colon cancer treatment may include resection of the primary tumor. Current use of primary tumor surgery (PTS) in clinical practice is unknown. This study examined utilization and determinants of PTS and evaluated its effect on survival. Methods: Using national Surveillance, Epidemiology, and End Results registry data, stage IV colon cancer patients diagnosed from 1998-2008 were identified. Data on demographics, PTS, and tumor features were collected. Temporal changes in receipt of PTS were examined over 3 periods (1998-2000, 2001-2004, 2005-2008). Multiple logistic regression was used to identify significant determinants of PTS. 1- and 3-year cancer-specific survival was calculated in PTS and non-PTS patients. Cox proportional hazards models examined the effect of PTS on mortality risk. Results: 16,029 patients were identified. Median age was 69 (IQR: 57-78), and 50% were male. Approximately 67% of patients received PTS. Receipt of PTS significantly declined from 72% in 1998-2000 to 68% in 2001-2004, and 63% in 2005-2008 (p<0.01). Results from the logistic regression analysis showed that patients who were younger, white, married, had right sided cancer and higher tumor grade were more likely to receive PTS (all p<0.01). The 1- and 3-year survival was higher in patients who received PTS compared with those who did not (1-year: 55% (95% CI: 54-56) vs. 24% (95% CI: 23-26); 3-year: 19% (95% CI: 19-20) vs. 4% (95%CI: 3.4-4.9)). Adjusted for demographics and tumor features, risk of mortality was 54% (HR=0.46; 95% CI: 0.44-0.48) lower in patients who received PTS than those without PTS. Recent year of diagnosis (HR=0.88; 95% CI: 0.75-0.80) and being married (HR=0.90, 95% CI: 0.86-0.95) were associated with lower mortality. Older age (HR=1.48; 95% CI: 1.39-1.56), black race (HR=1.09; 95% CI: 1.03-1.15), right sided cancer (HR=1.21; 95% CI: 1.17-1.26), and poorly differentiated tumors (HR= 1.62; 95% CI: 1.46-1.80) were associated with increased mortality. Conclusions: PTS utilization for stage IV colon cancer has significantly declined, yet survival was higher in patients who received PTS. However, these findings are limited by the absence of co-morbidity and chemotherapy data.

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Obesity and its impact on outcomes in stage III colon cancer (CC) patients receiving adjuvant chemotherapy (AC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.627 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 627-627

Author(s):

Qirui Ding ◽

Geoff McKinnon ◽

Yuan Xu ◽

Winson Y. Cheung

Keyword(s):

Proportional Hazards ◽

Population Based ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Stage Iii ◽

Time Interval ◽

Obese Patients ◽

Cancer Specific Survival ◽

Cox Models ◽

The Impact

627 Background: Obesity may complicate CC surgery, which can result in potential AC delays. We aimed to determine the effect of body mass index (BMI) and body surface area (BSA) on CC outcomes, accounting for variations in the time interval between surgery and AC. Methods: We analyzed a population-based cohort of patients from Alberta, Canada who were diagnosed with stage III CC from 2011 to 2016 and underwent AC. Patients were grouped based on their baseline BSA (underweight, < 20 kg/m2; normal, 20-24; overweight, 25-29; obese ≥ 30) and BMI (< 2 m2 vs ≥ 2 m2). Logistic regression models were constructed to examine the effect of BMI/BSA on delays between surgery and AC. The Kaplan-Meier method was used to estimate overall (OS) and cancer-specific survival (CSS) and Cox proportional hazards models were developed to evaluate the impact of BMI/BSA on these outcomes, adjusting for confounders. Results: We examined 915 patients: median age was 64 years, 510 (56%) were men and 155 (17%) had a Charlson comorbidity index (CCI) ≥ 2. In this cohort, 126 (14%), 623 (68%) and 166 (18%) were stage IIIA, IIIB and IIIC, respectively. In total, 132 (14%) were underweight, 452 (49%) normal weight, 233 (26%) overweight and 98 (11%) obese. Based on the Mosteller formula, 527 (58%) patients had normal BSA and 368 (42%) had high BSA. Obese patients were more likely to be men (67% vs 56%, p < 0.001) and had worse CCI (28% vs 17% with CCI ≥ 2, p = 0.03) when compared to non-obese patients. Neither BMI (p = 0.14) nor BSA (p = 0.44) correlated with AC delays after surgery. Similar OS and CSS were observed regardless of BMI and BSA (p = 0.76 and 0.80 for OS and p = 0.60 and 0.89 for CSS, respectively). In multivariate Cox models, only worse nodal stage was associated with inferior OS and CSS (HR 4.74, 95%CI 1.96-11.47, p < 0.001 for OS; HR 4.92, 95%CI 1.42-17.00, p = 0.006 for CSS, comparing IIIC vs IIIA), but BMI and BSA were not (see Table). Conclusions: Obesity as measured by BMI and BSA did not correlate with AC delays or worse outcomes in stage III CC patients. [Table: see text]

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Radiotherapy Improves the Survival of Patients With Metastatic Cervical Cancer: A Propensity-Matched Analysis of SEER Database

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001313 ◽

2018 ◽

Vol 28 (7) ◽

pp. 1360-1368 ◽

Cited By ~ 1

Author(s):

Kejie Huang ◽

Mingfang Jia ◽

Ping Li ◽

Jianglong Han ◽

Rui Zhang ◽

...

Keyword(s):

Cervical Cancer ◽

Nearest Neighbor ◽

Proportional Hazards ◽

Figo Stage ◽

Population Based ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cancer Specific Survival ◽

Gynecology And Obstetrics ◽

End Results

ObjectiveTo demonstrate whether radiotherapy has an effect on the survival of patients with stage IVb (M1) cervical cancer, as it has not been adequately clarified.MethodsWe analyzed International Federation of Gynecology and Obstetrics (FIGO) stage M1 cervical cancer diagnosed in patients between 1992 and 2013 using population-based data from the Surveillance, Epidemiology, and End Results registry. Propensity score (PS) analysis with 1:1 matching and the nearest neighbor matching method was performed to ensure well-balanced characteristics of comparison groups. Data were analyzed by Kaplan-Meier and Cox proportional hazards regression models to evaluate the overall survival (OS) and cancer-specific survival (CSS) months with corresponding 95% confidence intervals (95% CIs).ResultsIn general, receiving radiotherapy significantly improved OS and CSS both before and after PS matching (PSM) (P< 0.001), with significantly improved OS (hazard ratio, 0.69; 95% CI, 0.62-0.76) and CSS (hazard ratio, 0.79; 95% CI, 0.70-0.89) after PSM in patients with stage M1 cervical cancer. Before PSM, radiotherapy was found to be associated with improved survival even for the patients with stage M1 cervical cancer with extensive metastasis (≥2 metastatic sites) (P< 0.001). AlthoughPvalue was not significant for brain metastasis, the survival month was numerically improved before PSM (OS and CSS, 1 month vs 4 months). Overall, radiotherapy still significantly improved survival for patients with one metastatic site (ie, oligometastases) either before or after PSM (P< 0.05), with the survival month improved more than 6 months.ConclusionsThe large Surveillance, Epidemiology, and End Results results support that radiotherapy might improve the survival of patients with metastatic cervical cancer. It might be prudent to carefully select suitable patients for radiation therapy for metastatic cervical cancer.

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Characteristics and prognosis of pelvic Ewing sarcoma: a SEER population-based study

PeerJ ◽

10.7717/peerj.7710 ◽

2019 ◽

Vol 7 ◽

pp. e7710

Author(s):

Li Chen ◽

Cheng Long ◽

Jiaxin Liu ◽

Fei Xing ◽

Xin Duan

Keyword(s):

Prognostic Factors ◽

Ewing Sarcoma ◽

Tumor Size ◽

Proportional Hazards ◽

Multivariate Analyses ◽

Survival Rates ◽

Tumor Stage ◽

Population Based ◽

Cox Proportional Hazards ◽

Survival Prediction

Background The pelvis is one of the primary sites of Ewing sarcoma (ES) and is associated with poorer prognoses than the extremities. Due to the rarity of this disease and limited data available, the prognostic factors of pelvic ES remain controversial. Thus, this study aimed to identify independent prognostic factors, and develop a nomogram for predicting survival rates in patients with pelvic ES. Methods Using data provided by the Surveillance, Epidemiology, and End Results (SEER) database, variables including age, sex, race, tumor size, tumor stage, surgery, and radiotherapy were analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Based on the results of multivariate analyses, a nomogram was built to predict the overall survival (OS) of patients with pelvic ES. The performance of the nomogram was evaluated by the concordance index (C-index). Results A total of 267 cases diagnosed between 2004 and 2016 were included in the study. Univariate and multivariate analyses showed that patients who were younger, white, had a localized tumor stage, or underwent surgery were associated with improved prognoses, while no significant differences were observed in OS based on sex, tumor size, or radiotherapy. A nomogram was developed and the C-index was 0.728, indicating adequate performance for survival prediction. Conclusions Age, race, tumor stage, and surgery were identified as independent prognostic factors for the OS of pelvic ES. The nomogram developed in this study can individually predict 3- and 5-year OS in patients with pelvic ES.

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Endoscopic and Surgical Treatment of T1N0M0 Colorectal Neuroendocrine Tumors: A Population-Based Comparative Study

10.21203/rs.3.rs-34558/v1 ◽

2020 ◽

Author(s):

Hanlong Zhu ◽

Si Zhao ◽

Kun Ji ◽

Wei Wu ◽

Jian Zhou ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Tumor Size ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Modalities ◽

Cancer Specific Survival ◽

Term Survival ◽

Population Based Study

Abstract Background: With the rapid advances in endoscopic technology, endoscopic therapy (ET) is increasingly applied to the treatment of small (≤20 mm) colorectal neuroendocrine tumors (NETs). However, long-term data comparing ET and surgery for management of T1N0M0 colorectal NETs are lacking. The purpose of this work was to compare overall survival (OS) and cancer-specific survival (CSS) of such patients with ET or surgery.Methods: Patients with T1N0M0 colorectal NETs were identified within the Surveillance Epidemiology and End Results (SEER) database (2004-2016). Demographics, tumor characteristics, therapeutic methods, and survival were compared. Propensity score matching (PSM) was used 1:3 and among this cohort, Cox proportional hazards regression models were performed to evaluate correlation between treatment and outcomes.Results: Of 4487 patients with T1N0M0 colorectal NETs, 1125 were identified in the matched cohort, among whom 819 (72.8%) underwent ET and 306 (27.2%) underwent surgery. There was no difference in the 5-year and 10-year OS and CSS rates between the 2 treatment modalities. Likewise, analyses stratified by tumor size and site showed that patients did not benefit more from surgery compared with ET. Moreover, multivariate analyses found no significant differences in OS [Hazard Ratio (HR) = 0.857, 95% Confidence Interval (CI): 0.513–1.431, P = 0.555] and CSS (HR = 0.925, 95% CI: 0.282–3.040, P = 0.898) between the 2 groups. Similar results were observed when comparisons were limited to patients with different tumor size and site.Conclusions: In this population-based study, patients treated endoscopically had comparable long-term survival compared with those treated surgically, which demonstrates ET as an alternative to surgery in T1N0M0 colorectal NETs.

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Different Anatomical Subsites of Colon Cancer and Mortality: A Population-Based Study

Gastroenterology Research and Practice ◽

10.1155/2018/7153685 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Xing-kang He ◽

Wenrui Wu ◽

Yu-e Ding ◽

Yue Li ◽

Lei-min Sun ◽

...

Keyword(s):

Colon Cancer ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Underlying Mechanism ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Survival Outcomes ◽

Cancer Specific Survival ◽

Kaplan Meier

Background. In terms of incidence and pathogenesis, right-sided colon cancer (RCC) and left-sided colon cancer (LCC) exhibit several differences. However, whether existing differences could reflect the different survival outcomes remains unclear. Therefore, we aimed to ascertain the role of location in the prognosis. Methods. We identified colon cancer cases from the Surveillance, Epidemiology, and End Results database between 1973 and 2012. Differences among subsites of colon cancer regarding clinical features and metastatic patterns were compared. The Kaplan-Meier curves were conducted to compare overall and disease-specific survival in relation to cancer location. The effect of tumour location on overall and cancer-specific survival was analysed by Cox proportional hazards model. Results. A total of 377,849 patients from SEER database were included in the current study, with 180,889 (47.9%) RCC and 196,960 (52.1%) LCC. LCC was more likely to metastasize to the liver and lung. Kaplan-Meier curves demonstrated that LCC patients had better overall and cancer-specific survival outcomes. Among Cox multivariate analyses, LCC was associated with a slightly reduced risk of overall survival (HR, 0.92; 95% CI, 0.92-0.93) and cancer-specific survival (HR, 0.92; 95% CI, 0.91-0.93), even after adjusted for other variables. However, the relationship between location and prognosis was varied by subgroups defined by age, year at diagnosis, stage, and therapies. Conclusions. We demonstrated that LCC was associated with better prognosis, especially for patients with distant metastasis. Future trails should seek to identify the underlying mechanism.

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The natural history, treatment pattern, and survival of the patients with micropapillary bladder.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15015 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15015-e15015

Author(s):

Jue Wang

Keyword(s):

Natural History ◽

Tumor Stage ◽

Invasive Disease ◽

Population Based ◽

Bladder Tumors ◽

Cancer Specific Survival ◽

Undifferentiated Histology ◽

Primary Bladder ◽

Muscle Invasive ◽

Population Based Registry

e15015 Background: Micropapillary bladder carcinoma (MPBC) is a rare variant of urothelial carcinoma. The objective of this study was to examine the epidemiology, natural history, and prognostic factors of MPBC using population-based registry. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify cases of MPBC by tumor site and histology codes. The clinical, demographic characteristics, treatment and survival of MPBC were examined. Results: A total of 98 cases of histology confirmed MPBC were identified between 2001 and 2007, this accounted for approximately 0.01% of all primary bladder tumors during the study period. Median age of the patients was 72 years (range 26-95). Of all the patients with MPBC, 56.1% had muscle invasive disease; 75.5% of patients had poorly or undifferentiated histology. A total of 30.6% of all patients (2.3% superficial disease; 52.7% of muscle-invasive MPBC) had radical or partial cystectomy. By logistic regression analysis, nonmuscle-invasive MPBC (OR 62.5, 95% CI 7.2-542.3) was associated with lower rate of utilization of cystectomy. The 1-, 3- and 5-year overall survival rate of MPBC were 84.5%, 57.3% and 42.3%. In multivariate analysis, tumor stage (HR 4.7, 95% CI 1.0-21.8) was found to be the only significant predictor for cancer-specific survival. Conclusions: The optimal therapy for MPBC remains undermined. Emphasis on early detection is needed to improve the outcome for patients with this malignancy.

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A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

Canadian Urological Association Journal ◽

10.5489/cuaj.4402 ◽

2017 ◽

Vol 11 (9) ◽

pp. E344-9

Author(s):

Lindsay M. Yuh ◽

Primo N. Lara Jr ◽

Rebecca M. Wagenaar ◽

Christopher P. Evans ◽

Marc A. Dall'era ◽

...

Keyword(s):

Metastatic Disease ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Disease Stage ◽

Retroperitoneal Lymph Node Dissection ◽

Cancer Specific Survival ◽

Rare Tumour ◽

Prognostic Features ◽

Cox Proportional Hazards Models

Introduction: We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database.Methods: Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival.Results: A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presentedwith localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS.Conclusions: We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCSTis disease stage, emphasizing the importance of early detection and intervention.

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