Comparative survival analysis of melanoma patients with secondary papillary thyroid carcinoma using Surveillance, Epidemiology, and End Results (SEER) data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9068-9068
Author(s):  
E. D. Whitman ◽  
R. T. Bustami
Keyword(s):  
Proportional Hazards ◽  
Cox Model ◽  
Statistical Significance ◽  
Demographic Data ◽  
Cox Proportional Hazards ◽  
Second Primary ◽  
Papillary Thyroid ◽  
Chi Square ◽  
Risk Of Death ◽  
Significant Difference

9068 Background: Malignant melanoma (MM) and papillary thyroid cancer (PTC) may share genetic mutations. The expected mortality of a patient with both MM and PTC should be predominantly influenced by MM and unchanged by the PTC diagnosis, unless shared genetic abnormalities or other factors alter the phenotype of either or both diseases. We hypothesize patients with both MM and PTC have altered mortality risk compared to patients with either cancer alone. Methods: The study population included patients identified in the SEER 1973–2004 database who were diagnosed with MM or PTC as a primary tumor. The population was divided into four groups: (1) patients with MM only (MEL); (2) patients with PTC only (PAP); (3) patients who developed MM as a second primary after PTC (2MEL); and (4) patients diagnosed with PTC after MM (2PAP). Time between diagnosis and death or last follow up (December 2005) and other demographic data was obtained from SEER. Comparisons between the group death rates were made using the Chi-Square Test. A Cox proportional hazards regression model, adjusted for patient characteristics, predicted the risk of death and survival by group. Results: 9575 SEER patient records were included: 6622 in MEL, 2778 in PAP, 113 in 2MEL and 62 in 2PAP. Overall, 2095 patients (22%) died. There was a significant difference in mortality rates between the groups: MEL 27%, PAP 9%, 2MEL 21% and 2PAP 18%, p<0.001 by Chi-Square. Controlling for other variables in a multivariate Cox model, patients in the 2MEL group were significantly less likely to die than MEL patients (HR 0.52, 95% CI 0.35–0.79, p=0.002). 2PAP patients, the smallest sample, also had a reduced likelihood of death that did not reach statistical significance (HR=0.75, 95% CI 0.42–1.37, p=.35). PAP patients had the best survival (HR=0.43, 95% CI 0.36–0.50,p<0.001). Other factors (age, race, gender and radiation therapy, data not shown) also significantly affected mortality. Conclusions: This study suggests that MM patients also diagnosed with PTC are more likely to survive than patients with MM alone. Identification of the causative factor(s) for this survival benefit will require additional epidemiologic and genetic studies. No significant financial relationships to disclose.

Survival for melanoma patients with pre-existing chronic lymphocytic leukemia.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19057-e19057
Author(s):  
Eric D. Whitman ◽  
Rami Bustami
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Proportional Hazards ◽  
Cox Model ◽  
Cox Proportional Hazards ◽  
Lymphocytic Leukemia ◽  
Chi Square ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference

e19057 Background: Recent successes in melanoma drug development have rekindled interest in immunotherapy for melanoma (MM). Patients (pts) with chronic lymphocytic leukemia (CLL), a malignant expansion of B-lymphocytes, have an impaired immune system and not uncommonly develop secondary MM. We hypothesized that MM pts with pre-existing CLL are more likely to die than MM pts without a second malignancy. Methods: Pts were identified in the updated Surveillance Epidemiology and End Results (SEER) (1973-2008) database with MM only (MEL) or with primary CLL and secondary MM (MELpCLL). Time between diagnosis and death or last follow up and other demographic SEER data were recorded. The Chi-Square Test was used to make unadjusted comparisons between group death rates. A Cox proportional hazards regression model, adjusted for patient characteristics, predicted the risk of death by group. Results: 8,294 SEER pts were included (8,115 in MEL, 179 in MELpCLL). With a median follow-up time of 7 years, 2,454 pts (30%) died. There was a significant difference in mortality rates between the groups: MEL 29% / MELpCLL 71%; p<0.001 by Chi-Square. In the multivariate Cox model (Table), MELpCLL pts were significantly more likely to die than MEL pts (HR = 1.22, 95% CI = 1.02-1.46, p = 0.034). Higher risk of death was also significantly associated with older age and male gender (p<0.001) but not MM location (data not shown). MM data like thickness and ulceration were only available in more recent SEER records, precluding survival analysis. Conclusions: MELpCLL pts had a 22% increased risk of death compared to MEL pts in multivariate analysis, consistent with the hypothesis. [Table: see text]

scholarly journals Para-Aortic Nodal Radiation in the Definitive Management of Node-Positive Cervical Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Jason C. Sanders ◽  
Donald A. Muller ◽  
Sunil W. Dutta ◽  
Taylor J. Corriher ◽  
Kari L. Ring ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Chi Square ◽  
Node Positive ◽  
Significant Difference ◽  
Grade 3 ◽  
Severe Grade

ObjectivesTo investigate the safety and outcomes of elective para-aortic (PA) nodal irradiation utilizing modern treatment techniques for patients with node positive cervical cancer.MethodsPatients with pelvic lymph node positive cervical cancer who received radiation were included. All patients received radiation therapy (RT) to either a traditional pelvic field or an extended field to electively cover the PA nodes. Factors associated with survival were identified using a Cox proportional hazards model, and toxicities between groups were compared with a chi-square test.Results96 patients were identified with a mean follow up of 40 months. The incidence of acute grade ≥ 2 toxicity was 31% in the elective PA nodal RT group and 15% in the pelvic field group (Chi-square p = 0.067. There was no significant difference in rates of grade ≥ 3 acute or late toxicities between the two groups (p&gt;0.05). The KM estimated 5-year OS was not statistically different for those receiving elective PA nodal irradiation compared to a pelvic only field, 54% vs. 73% respectively (log-rank p = 0.11).ConclusionsElective PA nodal RT can safely be delivered utilizing modern planning techniques without a significant increase in severe (grade ≥ 3) acute or late toxicities, at the cost of a possible small increase in non-severe (grade 2) acute toxicities. In this series there was no survival benefit observed with the receipt of elective PA nodal RT, however, this benefit may have been obscured by the higher risk features of this population. While prospective randomized trials utilizing a risk adapted approach to elective PA nodal coverage are the only way to fully evaluate the benefit of elective PA nodal coverage, these trials are unlikely to be performed and instead we must rely on interpretation of results of risk adapted approaches like those used in ongoing clinical trials and retrospective data.

Integration of bone scan (BS) and computerized tomography (CT) findings as an endpoint to assess bone metastasis in metastatic castration-resistant prostate cancer (mCRPC).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 191-191
Author(s):  
Scott J. Parker ◽  
Gregory Russell Pond ◽  
Guru Sonpavde ◽  
Anitha Alex ◽  
Marta Elise Heilbrun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Bone Metastasis ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Bone Lesions ◽  
Castration Resistant Prostate Cancer ◽  
Ct Findings ◽  
Significant Difference

191 Background: Progression of bone metastasis in mCRPC is assessed solely by BS findings and correlates modestly with overall survival (OS). Given the lack of reliability of BS findings and the ready availability of routinely performed CT scans, which commonly identify bone metastases, we aimed to better assess progression in bone by integrating BS and CT findings and to explore their association with OS. Methods: Data were obtained from patients treated at the University of Utah receiving docetaxel-based chemotherapy (D) or post-docetaxel therapy with orteronel (O). Patients with both baseline and on-therapy CT and BS within 90 days were eligible for analysis. CT and BS underwent central radiology review for bone lesions by a single radiologist. Progressive disease (PD) was defined as ≥ 1 new lesion. Survival was measured from start of therapy. Cox proportional hazards regression was used to explore potential prognosticators of overall survival (OS). Statistical significance was defined as 2-sided p < 0.05. Therapy was a stratification factor. Results: Twenty-eight patients were evaluable including 18 patients receiving D, and 10 receiving O post-docetaxel. The mean age of these patients was 71.4 years and median (95% CI) overall survival was 18.4 (9.7-35.4) months. Four patients had PD on both BS and CT, while 2 (7%) had PD on CT but not BS and 3 had PD on BS but not CT. Patients with PD on BS or CT had worse OS (HR = 2.68, 95% CI = 1.04-6.90, p = 0.041) than those with no PD on either CT or BS. Looking at individual lesions, 4 (14%) patients had new lesions identified on CT which was not observed using BS, and they were associated with worse OS (HR = 3.72, 1.01-13.66, p = 0.048). Conversely, no significant difference in OS was observed for 4 patients with lesions identified on BS which were not observed using CT (HR = 2.67, 0.58-12.32, p = 0.21). Conclusions: This hypothesis-generating study suggests that CT can complement and enhance the ability of BS to capture PD and predict OS. Integration of BS findings using Prostate Cancer Working Group (PCWG)-3 guidelines to define PD and CT bone findings should be investigated in a larger study as an intermediate endpoint.

scholarly journals Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

2020 ◽  
Author(s):  
Payam Peymani ◽  
Tania Dehesh ◽  
Farnaz Aligolighasemabadi ◽  
Mohammadamin Sadeghdoust ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Statin Treatment ◽  
Careful Consideration ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Risk Of Death ◽  
Statin Use

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

scholarly journals Malignant Progression Contributes to the Failure of Combination Therapy for Atypical Meningiomas

2021 ◽  
Vol 10 ◽  
Author(s):  
Qing Zhang ◽  
Zheng Wen ◽  
Ming Ni ◽  
Da Li ◽  
Ke Wang ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Proportional Hazards ◽  
External Beam Radiotherapy ◽  
Cox Proportional Hazards ◽  
Malignant Progression ◽  
Karnofsky Performance Scale ◽  
Chi Square ◽  
Ki 67 ◽  
Significant Difference ◽  
Atypical Meningiomas

ObjectiveTo investigate the independent risk factors for recurrence in intracranial atypical meningiomas (AMs) treated with gross total resection (GTR) and early external beam radiotherapy (EBRT).MethodsClinical, radiological, and pathological data of intracranial AMs treated with GTR-plus-early-EBRT between January 2008 and July 2016 were reviewed. Immunohistochemical staining for Ki-67 was performed. Kaplan–Meier curves and univariate and multivariate Cox proportional hazards regression analyses were used to explore independent predictors of tumor recurrence. Chi square test was performed to compare variables between subgroups.ResultsForty-six patients with intracranial AMs underwent GTR and early EBRT. Ten (21.7%) recurred and three (6.5%) died during a median follow-up of 76.00 months. Univariate and multivariate Cox analyses revealed that malignant progression (MP) (P = 0.009) was the only independent predictor for recurrence, while Ki-67 was of minor value in this aspect (P = 0.362). MP-AMs had a significantly higher recurrence rate (P = 0.008), a higher proportion of irregularly shaped tumors (P = 0.013) and significantly lower preoperative Karnofsky Performance Scale (KPS) scores (P = 0.040) than primary (Pri) AMs. No significant difference in Ki-67 expression was detected between these subgroups (P = 0.713).ConclusionsMP was significantly correlated with an increased incidence of recurrence in GTR-plus-early-EBRT-treated intracranial AMs. Significantly higher frequencies of tumor relapse and irregularly shaped tumors and lower preoperative KPS scores were observed in MP-AMs compared with Pri-AMs. Ki-67 expression is of minor value in predicting tumor recurrence or distinguishing tumor origins in AMs.

Nutritional status and outcomes of older versus younger patients (pts) with metastatic pancreatic cancer (mPC).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 386-386
Author(s):  
Namrata Vijayvergia ◽  
Jenny Y Seo ◽  
Karthik Devarajan ◽  
Crystal Shereen Denlinger ◽  
Steven J. Cohen ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
Nutritional Status ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Total Study Population ◽  
Exact Test ◽  
Risk Of Death ◽  
Significant Difference

386 Background: Older mPC pts are less likely to receive chemotherapy (Ctx) and receive fewer agents compared to younger pts, yet have similar overall survival (OS). Both obesity and malnutrition are linked with poorer outcomes in pancreatic cancer. We evaluated the effect of body mass index (BMI) and nutritional state on survival in < 65 y (GpA) and > 65 y (GpB) mPC pts. Methods: With IRB approval, we retrospectively analyzed charts of 579 mPC pts treated between 2000 and 2010. GpA and GpB were compared based on BMI alone (<19, 20-25 and >25) and also their nutritional status (poor: albumin <3 or weight loss>15% during disease course with any BMI; good: Alb>3.5 + Wt loss<15% + BMI >20; intermediate: all others). Log-rank tests and Cox proportional hazards models were used to analyze OS and Fisher’s exact test to compare categorical variables. Results: There were 299 pts in GpA (median age 57yr) and 280 pts in GpB (median age 73 yr). Information on BMI/albumin was missing for 126 pts; total study population was 454 (GpA 238, GpB 216).Groups were well balanced for gender (majority male), PS (majority ≤1), initial stage (majority IV), and primary site (majority head). There was no significant difference in Ctx and number of agents used between the 3 subgroups across GpA and GpB. BMI alone did not affect survival in both groups. Nutritional status was significantly associated with survival when evaluating the whole population and GpA, but not GpB (Table). Good nutrition GpA pts had a lower relative risk of death versus pts in intermediate and poor nutrition groups (RR 0.83, CI 0.71-0.96, p=0.02). Good nutritional status was associated with better survival in GpA on multivariate analysis (RR=0.81, CI 0.69-0.95; p=0.008,), but not in GpB. Conclusions: Nutritional status (defined by BMI, albumin and weight loss) was associated with survival in younger mPC pts but not in older pts. Greater attention to nutrition and cancer cachexia with possible interventions throughout treatment may improve survival in mPC pts undergoing chemotherapy, especially those < 65 yrs. Table [Table: see text]

scholarly journals Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Payam Peymani ◽  
Tania Dehesh ◽  
Farnaz Aligolighasemabadi ◽  
Mohammadamin Sadeghdoust ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Statin Treatment ◽  
Careful Consideration ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Risk Of Death ◽  
Statin Use

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93), P = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72), P = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61–2.99), P = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07–2.33), P = 0.312]. Conclusions Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

scholarly journals The association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a cohort study

2019 ◽  
Author(s):  
Yangpei Peng ◽  
Yangjing Xue ◽  
Jinsheng Wang ◽  
Huaqiang Xiang ◽  
Kangting Ji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiogenic Shock ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Albumin Ratio

Abstract Background Cardiogenic shock (CS) is a lethal complication. Given the poor outcome of CS, we performed a retrospective cohort study to identify whether the neutrophil-to-albumin ratio (NAR) was significantly associated with mortality from CS. Methods All patient data were extracted from the MIMIC III version 1.3. Comparisons between groups was made using the chi-square or Fisher’s exact tests for categorical variables and the variance analysis or the Kruskal-Wallis test was used for continuous variables. The primary outcome was 30-day mortality and the secondary ones were 90-day and 365-day mortality. We used Cox proportional hazards models to evaluate the association between the various categories of NAR and survival. To further identify the association, subgroup analyses were performed. Results A total of 475 patients with CS were enrolled. A significant positive correlation between NAR levels and 30-day, 90-day or 365-day mortality was observed. For the primary outcome of 30-day mortality, the HR (95% CI) values given NAR levels 23.54–27.86 and > 27.86 were 1.72 (1.17, 2.53) and 1.96 (1.34, 2.87) compared with the reference (NAR < 23.47) in tertile analysis. In multivariate analyses, the HR (95% CI) values were still of statistical significance[1.98 (1.25, 3.15) and 2.03 (1.26, 3.26)]. When quintiles were applied to grouping patients according to NAR level, similar associations were also observed. For the secondary outcomes, the upward trend remained statistically significant. Conclusions NAR level was associated with survival from CS. NAR appeared to be an independent and readily-available prognostic biomarker of mortality in patients with CS.

Prognostic factors of overall (OS) and relapse-free survival (RFS) for patients with acute myeloid leukemia (AML) in remission after intensive chemotherapy (IC): Multivariate analyses from the QUAZAR AML-001 trial of oral azacitidine (Oral-AZA).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7014-7014
Author(s):  
Gail J. Roboz ◽  
Andrew H. Wei ◽  
Farhad Ravandi ◽  
Christopher Pocock ◽  
Pau Montesinos ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Model ◽  
Geographic Region ◽  
Cox Proportional Hazards ◽  
Significant Independent Predictor ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
First Remission ◽  
Ecog Ps ◽  
To Receive

7014 Background: Demographic and disease factors influence outcomes for patients (pts) with AML. In the phase 3 QUAZAR AML-001 trial, Oral-AZA significantly prolonged OS and RFS vs. placebo (PBO) for pts with AML in first remission after IC (Wei, NEJM, 2020). Univariate analyses showed OS and RFS benefits with Oral-AZA vs. PBO across pt subgroups defined by baseline (BL) characteristics. MV analyses were performed to identify BL characteristics independently predictive of OS/RFS in QUAZAR AML-001, and to assess Tx effects of Oral-AZA vs. PBO on survival when adjusted for BL factors. Methods: Pts were aged ≥55 yrs with AML in complete remission (CR) or CR with incomplete count recovery (CRi) after induction ± consolidation. Within 4 months of CR/CRi, pts were randomized 1:1 to receive Oral-AZA 300 mg or PBO for 14d/28d cycle. Cox proportional hazards models were used to estimate Tx effects of Oral-AZA vs. PBO on OS and RFS, adjusting for BL age, sex, ECOG PS score, cytogenetic risk at diagnosis (Dx), prior MDS, geographic region, CR/CRi after induction (per investigator) and at BL (per sponsor), MRD status, receipt of consolidation, number of consolidation cycles, platelet count, and ANC. In a stepwise procedure, randomized Tx and BL variables were selected incrementally into a Cox model if P ≤ 0.25. After each addition, the contribution of the covariate adjusted for other covariates in the model was evaluated and retained in the model if P ≤ 0.15. Results : Oral-AZA Tx remained a significant independent predictor of improved OS (HR 0.70) and RFS (HR 0.57) vs. PBO after controlling for BL characteristics (Table). MRD status, cytogenetic risk, and pt age were each also independently predictive of OS and RFS. Response after induction (CR vs. CRi) and BL ANC were predictive of OS but not RFS, whereas prior MDS, CR/CRi at BL, and number of consolidation cycles were only predictive of RFS. Conclusions: Tx with Oral-AZA reduced the risk of death by 30% and risk of relapse by 43% vs. PBO independent of BL characteristics. Cytogenetic risk at Dx, MRD status, and pt age also independently predicted survival outcomes. Clinical trial information: NCT01757535. [Table: see text]

Incidence and survival of patients with T0N1 breast cancers.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 56-56
Author(s):  
Shoko Emily Abe ◽  
Kendall W. Carpenter ◽  
Yimei Han ◽  
Teresa Flippo ◽  
Terry Sarantou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Breast Cancer Incidence ◽  
Cox Proportional Hazards ◽  
Breast Cancers ◽  
Chi Square ◽  
Cox Proportional Hazards Models ◽  
Seer Data ◽  
Chi Square Test

56 Background: As imaging modalities have improved, breast cancers are increasingly detected at earlier stages. Patients rarely present with axillary disease but no mammographically evident breast tumor. Based on analysis of Surveillance, Epidemiology and End Results (SEER) data, we determined that there has been an increase in incidence of T1aN1 breast cancers. In response, we hypothesize that T0N1 breast cancer incidence has decreased with increased MRI use. Moreover, SEER analysis showed that T1aN1 patients have worse survival than T1bN1 patients. We thus hypothesize that T0N1 patients have worse survival than T1N1 patients. Methods: We identified 36,093 female patients diagnosed with T0-1 N1 invasive breast cancer from the SEER database. We compared patient and tumor characteristics: age, race, histology, hormone receptor status, and diagnosis year group (1990-1994, 1995-1999, 2000-2005, 2006-2010) – by TN category (T0N1/T1aN1/T1bN1/T1cN1) using chi-square test and ANOVA. Kaplan-Meier method was used to estimate disease specific survival (DSS) for each TN category and diagnosis year group separately. Adjusted hazard ratios were estimated using Cox proportional hazards models. Results: Stage distribution was: T0N1=129, T1aN1=1294, T1bN1=6731, and T1cN1=27942 patients. Median ages were 59.6, 56.3, 59.1, and 58.1, respectively. Time trend analysis of T0N1 cancers showed an increase in incidence from 1990 to 1999 and stability after 2000. Five-year DSS was significantly worse for patients with T0N1 tumors than T1aN1 tumors (84.5% versus 94.1%, HR 0.513, p < 0.0001). T0N1 tumors were more likely to be ER negative than T1b-cN1 tumors (23% versus 16%, p < 0.0001). T0N1 tumors were also more likely to be ER negative than T1aN1 tumors, but did not reach statistical significance (23% vs. 20%, p = 0.09). The proportion of lobular cancers was significantly higher in T0N1 than T1aN1 or T1b-cN1 patients (18% versus 8%, p < 0.0001). Conclusions: Our analysis suggests that T0N1 tumors may differ biologically from T1N1 tumors. Although the incidence of T0N1 tumors did not decrease, it remained stable after 2000 when the use of MRI for occult breast cancers became widely accepted. Our second hypothesis that survival is worse in patients with T0N1 tumors was confirmed by our analysis.

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