Comparison of prognostic factors and survival outcome between gastrointestinal tract and cutaneous invasive malignant melanoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 618-618
Author(s):  
Chi Lin ◽  
Christopher K Brown ◽  
Charles Arthur Enke ◽  
Fausto R. Loberiza
Keyword(s):  
Prognostic Factors ◽  
Proportional Hazards ◽  
Early Stage ◽  
Female Gender ◽  
Cox Proportional Hazards ◽  
Lymph Node Status ◽  
Cancer Specific Survival ◽  
White Race ◽  
Factors Associated ◽  
Cox Analysis

618 Background: Gastrointestinal melanoma (GIM) is a rare disease. The objective of this study is to compare the overall survival (OS), cancer specific survival (CSS) and prognostic factors of GIM to those of skin melanoma (SKM) using the Surveillance, Epidemiology, and End Results (SEER) registry. Methods: Patients diagnosed with invasive GIM (406) and SKM (173,622) between 1973 and 2008 were identified from the SEER database. Factors analyzed included age (18-40/41-60/61-100), gender, race (White/nonwhite), marital status, stage (localized/regional/distant), year of diagnosis (1973-87/1988-97/1998-2008), and type of treatment (radiotherapy (RT)/surgery). OS and CSS were evaluated using the Kaplan-Meier method. Cox proportional hazards regression analysis examined what factors were prognostic of survival. Results: The median age was 69 and 57 for patients with GIM and SKM, respectively. The GIM group was older with more advanced-stage cancer than the SKM group. Surgery was performed on 85% and 95%, while RT was received by 18% and 2% of GIM and SKM patients, respectively. The GIM group had a median OS and CSS of 15 and 16 months, respectively, while the SKM group had a median OS of 283 months and did not reach a median CSS. Cox analysis showed that SKM had significantly lower risk of total and cancer-specific mortality compared to GIM (Hazard Ratio (HR) 0.40, p<0.0001) and (HR 0.34, p<0.0001). Factors associated with improved OS and CSS in SKM included: age ≤60, female gender, non-white race, early stage, being married, more recent diagnosis, undergoing surgery and not receiving RT. Factors associated with improved OS and CSS in GIM included: age ≤60, early stage, non-white race and undergoing surgery. Subgroup analysis on patients who underwent surgery showed that lymph node status was the only prognostic factor for GIM, while all of the previously identified prognostic factors except for race were associated with OS and CSS for SKM. Conclusions: Outcomes of patients with GIM are inferior to those with SKM. The melanomas in these two sites also have different prognostic factors. Future studies should explore the reasons behind these differences to improve treatment outcomes.

scholarly journals Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study

2016 ◽  
Vol 10 (9-10) ◽  
pp. 321 ◽  
Author(s):  
R. Christopher Doiron ◽  
Melanie Jaeger ◽  
Christopher M. Booth ◽  
Xuejiao Wei ◽  
D. Robert Siemens
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Long Term Outcomes ◽  
Cancer Specific Survival ◽  
Factors Associated ◽  
Provider Volume

Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice.Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use.Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75‒0.96) and male sex (female sex RR 0.89, 95% CI 0.79‒0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87‒1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80‒1.03; p=0.136).Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC.

Prognostic factors and survival of patients with brain metastasis (BM) from breast cancer (BC) who underwent craniotomy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22017-e22017
Author(s):  
Jose Pablo Leone ◽  
Diana E. Cunningham ◽  
Adrian Lee ◽  
Rohit Bhargava ◽  
Ronald L. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Primary Diagnosis ◽  
Cox Proportional Hazards ◽  
Factors Associated ◽  
Brain Radiotherapy ◽  
Whole Brain Radiation ◽  
First Recurrence

e22017 Background: BC is the second most frequent cause of BM after lung cancer, with metastases occurring in 10-16% of all patients. BM in patients with BC is a catastrophic event that results in poor prognosis. Identification of prognostic factors associated with breast cancer brain metastases (BCBM) could help to identify patients at risk. The aim of this study was to assess clinical characteristics, prognostic factors and survival of patients with BCBM who had craniotomy and resection in a series of patients treated with modern multimodality therapy. Methods: We analyzed 42 patients with BCBM who underwent resection. Patients were diagnosed with BC between April 1994 and May 2010. Cox proportional hazards regression was selected to describe factors associated with time to BM, survival from the date of first recurrence, and overall survival (OS). Results: Median age was 51 years (range 24-74). Median follow-up was 4.2 years (range 0.6-18.5). The mean time to BM from primary diagnosis was 49 months (range 0-206.22). Patients had a median of 2 BM with a median size of 3.25 cm. The proportion of the biological subtypes of BC was ER+/HER2- 25%, ER+/HER2+ 15%, ER-/HER2+ 30% and ER-/HER2- 30%. Brain radiotherapy was given to 28 patients, of which 10 had stereotactic radiosurgery, 7 whole brain radiation, and 11 both. Median OS from the date of primary diagnosis was 5.74 years. Median survival after diagnosis of BM was 1.33 years. In multivariate Cox regression analyses, stage was the only factor associated with shorter time to the development of BM (P=0.059), whereas age was the only factor associated with survival from the date of recurrence (P=0.027) and with OS (P=0.037). Controlling for age and stage, neither the biological subtype of cancer, the radiation modality nor the site of first recurrence showed any impact on survival. Conclusions: Stage at primary diagnosis correlated with shorter time to the development of BM, while age at diagnosis was associated with shorter survival in BCBM. None of the other clinical factors had influence on survival.

Aspirin use and survival outcomes in patients (pts) with PIK3CA mutant colorectal cancer (CRC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3598-3598
Author(s):  
Ben Tran ◽  
Robert N Jorissen ◽  
Jayesh Desai ◽  
Fiona Day ◽  
Lara Rachel Lipton ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Proportional Hazards ◽  
Early Stage ◽  
Pik3ca Mutation ◽  
Predictive Biomarker ◽  
Outcome Data ◽  
Cox Proportional Hazards ◽  
Cancer Specific Survival ◽  
Pik3ca Mutations ◽  
Aspirin Group

3598 Background: Aspirin has an established role in preventing CRC. Recent data suggests aspirin use may also benefit a subset of pts diagnosed with CRC. In one series, the authors identified PIK3CA mutations as a potential predictive biomarker for aspirin use, reporting that PIK3CA mutant CRC pts receiving aspirin had superior cancer specific survival (CSS) compared to those not receiving aspirin (HR 0.18, p<0.001), whereas in pts with wildtype PIK3CA, aspirin had no survival impact. Our study aims to confirm the survival benefit associated with aspirin use in pts with PIK3CA mutant CRC. Methods: A cohort of CRC pts with PIK3CA mutations (Sanger sequencing) was identified. Prospectively collected clinicopathological, treatment and outcome data was available. Aspirin use was confirmed by chart review. CSS and overall survival (OS) analyses were conducted using Cox proportional hazards in univariate and multivariate settings. Recurrence free survival (RFS) analyses were limited to early stage CRC pts (Stage A-C). Statistical differences in 5-year CSS (5YS) rates were calculated using Fisher’s exact test. Results: From a cohort of 1,019 CRC pts with known PIK3CA mutation status, 121 (12%) harbored PIK3CA mutations. Of these, 112 (92%) had aspirin usage data available: 27 (24%) pts used aspirin, 85 (76%) did not. In the aspirin group, there were 22 (81%) early stage and 5 (19%) metastatic CRC pts; in the no-aspirin group, there were 59 (69%) early stage and 26 (31%) metastatic CRC pts. In univariate analyses, aspirin use was not associated with superior CSS (HR 0.57, p=0.21), OS (HR 0.83, p=0.57), or RFS (HR 0.72, p=0.57). In multivariate analyses, aspirin use was not associated with improved OS (HR 1.07, p=0.86), CSS (HR 1.04, p=0.94) or RFS (HR 0.54, p=0.34). In 69 (62%) pts with mature follow-up, there was a trend towards superior 5YS for aspirin users (69% v 42%, p=0.09), but this may reflect imbalances in stage at diagnosis. Conclusions: Our study was unable to confirm the recently reported survival benefit associated with aspirin use in pts with PIK3CA mutant CRC. Given the small numbers of pts, a modest survival benefit associated with aspirin use cannot be excluded. Analyses in an expanded cohort of early stage pts are underway.

Effect of Obesity on Prognosis After Early-Stage Breast Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Marianne Ewertz ◽  
Maj-Britt Jensen ◽  
Katrín Á. Gunnarsdóttir ◽  
Inger Højris ◽  
Erik H. Jakobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
The Impact

Purpose This study was performed to characterize the impact of obesity on the risk of breast cancer recurrence and death as a result of breast cancer or other causes in relation to adjuvant treatment. Patients and Methods Information on body mass index (BMI) at diagnosis was available for 18,967 (35%) of 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006 with complete follow-up for first events (locoregional recurrences and distant metastases) up to 10 years and for death up to 30 years. Information was available on prognostic factors and adjuvant treatment for all patients. Univariate analyses were used to compare the associations of known prognostic factors and risks of recurrence or death according to BMI categories. Cox proportional hazards regression models were used to assess the influence of BMI after adjusting for other factors. Results Patients with a BMI of 30 kg/m2 or more were older and had more advanced disease at diagnosis compared with patients with a BMI below 25 kg/m2 (P < .001). When data were adjusted for disease characteristics, the risk of developing distant metastases after 10 years was significantly increased by 46%, and the risk of dying as a result of breast cancer after 30 years was significantly increased by 38% for patients with a BMI of 30 kg/m2 or more. BMI had no influence on the risk of locoregional recurrences. Both chemotherapy and endocrine therapy seemed to be less effective after 10 or more years for patients with BMIs greater than 30 kg/m2. Conclusion Obesity is an independent prognostic factor for developing distant metastases and for death as a result of breast cancer; the effects of adjuvant therapy seem to be lost more rapidly in patients with breast cancer and obesity.

scholarly journals Rethinking the 8th AJCC System: Is It Suitable for Patients Aged <55 Years With Stage T4N1M0 Follicular Variant of Papillary Thyroid Carcinoma to Be Placed in Stage I?

2020 ◽  
Vol 10 ◽  
Author(s):  
Wei Long ◽  
Di Hu ◽  
Ling Zhou ◽  
Yueye Huang ◽  
Wen Zeng ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Stage Ii ◽  
Cancer Specific Survival ◽  
Factors Associated ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
New System

PurposeThe newest (8th) edition of the TNM staging system published in 2017. In this edition, some significant changes happened from the previous edition. As a result, down-staging appeared in nearly one third of DTC patients. However, we don’t know whether the new system predicts the survival of FVPTC patients accurately. Therefore, it is necessary to thoroughly evaluate the correlation between the new system and survival prediction in terms of FVPTC.MethodsWe enrolled 17,662 FVPTC patients from the Surveillance, Epidemiology, and End Results database. Factors associated with survival were identified by Cox regression analyses. The mortality rates per 1,000 person-years were calculated and compared. Cox proportional hazards regression quantified the risk of survival, and survival curves were produced by Kaplan-Meier analyses using log-rank tests.ResultsAge at diagnosis, race, T-stage at diagnosis, distant metastasis, radiation therapy, and surgery were independent factors associated with cancer-specific survival. Patients aged &lt;55 years with stage T4N1M0 FVPTC had higher mortality rates per 1,000 person-years than patients in the same stage according to the 8th AJCC System. Cox proportional hazards regression reflected that patients aged &lt;55 years with stage T1-3, any N, M0 or T4N0M0 disease (p=0.001) and patients aged ≥55 years with T1-2N0M0 disease (p=0.004) had significantly lower risks of cancer-specific survival (CSS) than those aged &lt;55 years with stage T4N1M0 disease. The CSS curve of patients aged &lt;55 years with stage T4N1M0 disease showed a decline on comparison with others belonging to stage I (p&lt;0.001); and the curve was even not different from patients in stage II and stage III (p&gt;0.05).ConclusionPatients aged &lt;55 years with stage T4N1M0 FVPTC had worse survival than patients in stage I; no difference was seen on comparison with stage II patients. We recommend this group of patients be upstaged in the 8th AJCC system.

Intervals Longer Than 20 Weeks From Breast-Conserving Surgery to Radiation Therapy Are Associated With Inferior Outcome for Women With Early-Stage Breast Cancer Who Are Not Receiving Chemotherapy

2009 ◽  
Vol 27 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Ivo A. Olivotto ◽  
Mary L. Lesperance ◽  
Pauline T. Truong ◽  
Alan Nichol ◽  
Tanya Berrang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Proportional Hazards ◽  
Reference Group ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Cox Proportional Hazards ◽  
Recurrence Free Survival ◽  
Cancer Specific Survival ◽  
Free Survival

PurposeTo determine the interval from breast-conserving surgery (BCS) to radiation therapy (RT) that affects local control or survival.Patients and MethodsThe 10-year Kaplan-Meier (KM) local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and breast cancer–specific survival (BCSS) were computed for 6,428 women who had T1 to 2, N0 to 1, M0 breast cancer that was diagnosed in British Columbia between 1989 and 2003, and who were treated with BCS and RT without chemotherapy. Intervals from BCS to RT were grouped by weeks as follows: ≤ 4 (n = 83), greater than 4 to 8 (n = 2,288; reference group); greater than 8 to 12 (n = 2,606); greater than 12 to 16 (n = 961); greater than 16 to 20 (n = 358); and greater than 20 weeks (n = 132). Cox proportional hazards models and matching were used to control for confounding variables.ResultsThe median follow-up time was 7.5 years. The 10-year KM outcomes were as follows: LRFS, 95.4%; DRFS, 90.5%; and BCSS, 92.5%. Compared with the greater than 4 to 8 weeks group, hazard ratios (HR) were not significantly different for any outcome among patients who were treated up to 20 weeks after BCS. However, LRFS (hazard ratio [HR], 2.00; P = .15), DRFS (HR, 1.86; P = .02) and BCSS (HR, 2.15; P = .009) were inferior for women with BCS-to-RT intervals greater than 20 weeks compared with those greater than 4 to 8 weeks. The matched analysis yielded similar results.ConclusionOutcomes were statistically similar for BCS-to-RT intervals up to 20 weeks, but they were inferior for intervals beyond 20 weeks. Time can be reasonably allowed for the breast to heal and for patients to consider treatment options, but RT should start within 20 weeks of BCS.

scholarly journals A practical nomogram for predicting cancer-specific survival in patients with clear-cell renal cell carcinoma

2020 ◽  
Author(s):  
Qian Wen ◽  
Xinwen Wang ◽  
Xiaoye Wang ◽  
Tiao Bai ◽  
Mei Tao
Keyword(s):  
Prognostic Factors ◽  
Proportional Hazards ◽  
Lung Metastases ◽  
Characteristic Curve ◽  
Staging System ◽  
Cox Proportional Hazards ◽  
Youden Index ◽  
Cell Renal Cell Carcinoma ◽  
Cancer Specific Survival ◽  
Net Reclassification Improvement

Abstract Background: It has limitations in predicting patient cancer-specific survival to use of the traditional American Joint Committee on Cancer (AJCC) staging system alone. Objectives: We aimed to establish and evaluate a comprehensive prognostic nomogram and compare its prognostic value with the AJCC-7th staging system in adults diagnosed with ccRCC.Methods: We used the SEER database to identify 24477 cases of ccRCC between 2010 and 2015. In the development cohort, we used multivariate Cox proportional-hazards analyses to select significant variables, and used R software to establish a nomogram for predicting the 3-year and 5-year cancer-specific survival rates of ccRCC patients. In the development and validation cohorts, we compared our cancer-specific survival model with the AJCC-7th prognosis model to evaluate the performance of the nomogram by calculating the concordance index (C-index), Youden Index, area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and performing calibration plotting and decision curve analyses (DCAs). Results: Eleven identified independent prognostic factors were used to establish the nomogram. Age at diagnosis, being unmarried, higher grades, larger tumor size, higher AJCC-7th stage, lymph node metastases, bone metastases, liver metastases, lung metastases, radiotherapy, and no surgery were risk factors for the cancer-specific survival of ccRCC. The C-index, Youden Index, AUC, NRI, IDI, and calibration plots demonstrated the good performance of the nomogram compared to the AJCC-7th staging system. Moreover, the 3-year and 5-year DCA curves showed that the nomogram yielded net benefits that were greater than the traditional AJCC-7th staging system. Conclusion: This study is the first to indicate that married status is an important prognostic parameter in ccRCC. Our results also demonstrate that the developed nomogram can predict cancer-specific survival more accurately than the AJCC-7th staging system alone. The prognostic factors were easily obtained.

Comparison of survival outcomes of rectal squamous cell carcinoma with rectal adenocarcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 745-745
Author(s):  
Chi Lin ◽  
Abhijeet Bhirud ◽  
Jinluan Li ◽  
Mary E. Charlton
Keyword(s):  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Early Stage ◽  
Rectal Adenocarcinoma ◽  
Cox Proportional Hazards ◽  
Entire Group

745 Background: Rectal squamous cell carcinoma (RSCC) is a rare disease. It is unclear whether the prognosis or treatment outcomes differ from that of rectal adenocarcinoma (RAC). The objective of this study is to compare the overall survival (OS), cancer specific survival (CSS) and prognostic factors of RSCC to those of rectal adenocarcinoma (RAC) using the Surveillance, Epidemiology, and End Results (SEER) registry. Methods: A total of 42,317 patients diagnosed with RSCC (999) and RAC (41,318) without distant metastasis between 1998 and 2011 were identified from the SEER database. Factors analyzed included histology (RSCC/RAC), age (≤56/>56), gender, race (white/nonwhite), tumor size (<5 cm/≥5 cm), grade (well-moderate/poor-undifferentiated), stage (local/regional), year of diagnosis (1998-2003/2004-2011), with or without surgery, and with or without radiotherapy (RT). OS and CSS were evaluated using the Kaplan-Meier method. Cox proportional hazards regression analysis was performed to examine the prognostic factors for survival. Results: The median follow up is 77 months (M). The entire group had 5 year OS and CSS of 62% and 77% with a median OS of 95 M but did not reach a median CSS. Compared to patients with RAC, patients with RSCC tend to be younger, female, diagnosed more recently, with less advanced stage but higher grade and larger tumor size. For patients with RSCC, 40% underwent surgery and 75% received RT. In contrast, for patients with RAC, 89% underwent surgery and 59% received RT. Patients with RSCC had a higher median OS than those with RAC (105 vs 94 M, Log-rank p <0.05). Cox proportional hazards analysis showed that patients with RAC had worse OS (hazard ratio [HR] 1.4) and CSS (HR 1.6) than patients with RSCC (p<0.05), after adjusting for all prognostic factors. Factors associated with improved OS and CSS in both RSCC and RAC included age ≤56, nonwhite, early stage, well-moderate differentiated, undergoing surgery and receiving RT. Gender is a prognostic factor for OS but not for CSS. Conclusions: Patients with rectal squamous cell carcinoma had a significantly superior OS and CSS than patient with rectal adenocarcinoma. Future studies should seek to explore the optimal management for these two distinct diseases.

scholarly journals Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: A retrospective cohort

2019 ◽  
Vol 20 (6) ◽  
pp. 716-724 ◽  
Author(s):  
Sotiria Manou-Stathopoulou ◽  
Emily J Robinson ◽  
John Julian Harvey ◽  
Narayan Karunanithy ◽  
Francis Calder ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cox Proportional Hazards ◽  
Lesion Length ◽  
Post Intervention ◽  
Stenotic Lesion ◽  
Factors Associated ◽  
High Data ◽  
Arteriovenous Fistulas

Introduction: Arteriovenous fistulas are the best form of vascular access for haemodialysis. A radiological balloon angioplasty is the standard treatment for a clinically relevant stenosis, but the recurrence rate is high. Data on factors associated with recurrence are limited. Methods: A single centre, retrospective analysis was performed for 124 consecutive patients who had successful interventions for dysfunctional arteriovenous fistulae, to examine factors associated with post-intervention patency. Follow-up was at least 1 year for all patients. Variables associated with primary and cumulative patency were pre-specified and assessed using both un-adjusted (univariate) and adjusted Cox proportional hazards models. Analysis was repeated for a subgroup of 80 patients with a single lesion only in order to examine the potential effects of stenotic lesion characteristics on patency. Results: Factors found to have a significant association with poorer outcomes (less time to loss of patency) included thrombosis at the time of intervention and a history of previous intervention. Fistula age (log days) was significantly associated with better outcomes (greater time to loss of patency). Non-white ethnicity, lesion length, and patient age were also significantly associated with accelerated loss of patency. Discussion: The factors we have identified as linked to poor outcome may help to identify patients in whom a balloon angioplasty is unlikely to provide a durable outcome. This may prompt exploring alternative treatment or dialysis options at an early stage.

scholarly journals Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study

2008 ◽  
Vol 26 (28) ◽  
pp. 4666-4671 ◽  
Author(s):  
Kelly-Anne Phillips ◽  
Richard H. Osborne ◽  
Graham G. Giles ◽  
Gillian S. Dite ◽  
Carmel Apicella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Psychosocial Factors ◽  
Proportional Hazards ◽  
Early Stage ◽  
Disease Free Survival ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Important Influence ◽  
Survival Models

Purpose Most women with early-stage breast cancer believe that psychosocial factors are an important influence over whether their cancer will recur. Studies of the issue have produced conflicting results. Patients and Methods A population-based sample of 708 Australian women diagnosed before age 60 years with nonmetastatic breast cancer was observed for a median of 8.2 years. Depression and anxiety, coping style, and social support were assessed at a median of 11 months after diagnosis. Hazard ratios for distant disease-free survival (DDFS) and overall survival (OS) associated with psychosocial factors were estimated separately using Cox proportional hazards survival models, with and without adjustment for known prognostic factors. Results Distant recurrence occurred in 209 (33%) of 638 assessable patients, and 170 (24%) of 708 patients died during the follow-up period. There were no statistically significant associations between any of the measured psychosocial factors and DDFS or OS from the adjusted analyses. From unadjusted analyses, associations between greater anxious preoccupation and poorer DDFS and OS were observed (P = .02). These associations were no longer evident after adjustment for established prognostic factors; greater anxious preoccupation was associated with younger age at diagnosis (P = .03), higher tumor grade (P = .02), and greater number of involved axillary nodes (P = .008). Conclusion The findings do not support the measured psychosocial factors being an important influence on breast cancer outcomes. Interventions for adverse psychosocial factors are warranted to improve quality of life but should not be expected to improve survival.

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