Time to surgery in colon cancer: Predictors and association with survival—An analysis of the National Cancer Database (NCDB).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 599-599
Author(s):  
Mohan Satish ◽  
Sarah J Aurit ◽  
Yang Zhang ◽  
Ryan W Walters
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
African American ◽  
Relative Risk ◽  
Regression Model ◽  
Older Age ◽  
Disease Stage ◽  
Adjusted Risk ◽  
Time To Surgery ◽  
Risk Of Death

599 Background: Time-to-surgery (TTS) refers to the wait time from the diagnosis of cancer to surgical resection of the primary tumor. In breast and bladder cancers, longer TTS has been shown to be associated with lower long-term survival. Prior evidence in colon cancer, has shown that older age, urban residence, and comorbidity are independent predictors of TTS. However, evaluation of TTS with survival in colon cancer has been limited to mostly single-center studies. Using the NCDB, this study aimed to both evaluate patient and clinical factors associated with TTS, and determine if TTS was associated with overall survival in colon cancer. Methods: Patients with colon cancer who underwent partial or subtotal colectomy/hemicolectomy were included, excluding those receiving neoadjuvant therapy. With prior colon cancer studies showing a median TTS of 15-20 days, we dichotomized the number of days from diagnosis to definitive surgery (TTS) as ≤ 21 days or > 21 days. A modified Poisson regression model was utilized to evaluate relative risk of TTS > 21 days. Overall survival in association with TTS was estimated using both the Kaplan-Meier method and multivariable Cox regression model, adjusting for patient-, disease- and facility-level characteristics. All analyses were conducted with SAS version 9.4, p-values < 0.05 were considered significant. Results: We identified 26,999 colon cancer patients from 2006-2012 from the NCDB. Approximately 25.7% of patients had a TTS > 21 days. Patients with comorbidities, who were older, were African American, with lower disease stage, and treated in academic facilities located in the Northeast, had a significantly increased relative risk of a TTS > 21 days. Considering survival, a TTS > 21 days was associated with a 24.5% decreased adjusted risk of death (95% CI: 21.6% to 27.2%). Conclusions: A longer TTS with colon cancer is understandably associated with older age, greater comorbidity, and lower stage, but questionably so in African American patients. However, given that TTS > 21 days was associated with a lower adjusted risk of death, it may indicate that a reasonable delay could be pursued for more accurate preoperative evaluation and staging in colon cancer.

Early Versus Late Computed Tomography and Nasal Endoscopy in the Diagnosis of Nasopharyngeal and Paranasal Sinus Malignancy

2019 ◽  
Vol 33 (4) ◽  
pp. 388-394 ◽  
Author(s):  
Michael J. Marino ◽  
Mei-Chin Hsieh ◽  
Eric L. Wu ◽  
Charles A. Riley ◽  
Xiao-Cheng Wu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Overall Survival ◽  
Relative Risk ◽  
Paranasal Sinus ◽  
Cancer Diagnosis ◽  
Clinical Utility ◽  
Early Cancer ◽  
Disease Stage ◽  
Nasal Endoscopy ◽  
Early Cancer Diagnosis

Background Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) may be associated with an increased risk of subsequent diagnosis of nasopharyngeal carcinoma (NPC) or paranasal sinus cancer (PSC) in elderly Americans. The clinical utility of this association remains uncertain. Objective To compare early computed tomography (CT) or nasal endoscopy (NE) with late diagnostic studies for the diagnosis of NPC or PSC in elderly Americans with CRS or AR. Methods The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was queried from 2003 to 2011 and included 150 088 Medicare beneficiaries. Patients with a diagnosis of CRS or AR were examined for either NE or CT performed within 6 months of the exposure diagnosis. The risk of a cancer diagnosis was determined between the early and the late diagnostic groups. Results The relative risk of early cancer diagnosis with NE was 1.98 (95% confidence interval [CI], 1.60–2.43). The number needed to detect (NND) a case of cancer with NE was 503 (95% CI, 387–718). The relative risk of an early cancer diagnosis using CT was 3.40 (95% CI, 2.85–4.06) and NND was 221 (95% CI, 194–255). The stage of NPC or PSC for the late diagnostic group was not different from those with early NE ( P = .458) or CT ( P = .497). Overall survival was not different between diagnostic groups for NE ( P = .789) or CT ( P = .425). Conclusions Early NE or CT is associated with a higher likelihood of cancer diagnosis in elderly individuals with a diagnosis of CRS or AR. The clinical utility of this association is limited due to the low prevalence of these malignancies and lack of difference in disease stage and overall survival between diagnostic groups.

scholarly journals Overall Survival and Response to Systemic Therapy in Metastatic Extrauterine Leiomyosarcoma

Sarcoma ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
A. N. Shoushtari ◽  
J. Landa ◽  
D. Kuk ◽  
A. Sanchez ◽  
B. Lala ◽  
...  
Keyword(s):  
Overall Survival ◽  
Systemic Therapy ◽  
Objective Response ◽  
Soft Tissue Sarcomas ◽  
Older Age ◽  
First Line ◽  
Risk Of Death ◽  
First Line Therapy ◽  
Line Therapy ◽  
Male Sex

Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy.Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1.Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) inN=113was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26–0.79,p=0.005).Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.

The effect of chemotherapy on overall survival of stage II colon cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 625-625
Author(s):  
M. Omaira ◽  
M. Mozayen ◽  
K. Katato
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Survival Rates ◽  
Stage Ii ◽  
Disease Stage ◽  
Overall Survival Rate ◽  
Significant Difference ◽  
Stage Ii Colon Cancer

625 Background: Surgical resection of local colon cancer is the only curative treatment, at the same time adjuvant chemotherapy is clearly shown to be beneficial as the standard of care for node positive disease (stage III) colon cancer. However the role of chemotherapy for stage II colon cancer treatment is still conflicting. We aim to compare the overall survival rate of stage II colon cancer patient's with and without chemotherapy. Methods: A retrospective observational study was conducted from 1990-2006. Patients with stage II colon cancer were included. Patient's characteristics including age, gender, common site of involvement, histology patterns, overall survival rate and treatment with chemotherapy were recorded. Results: A total of 138 consecutive patients were identified from 1990-2006. The median age was 68 (21-91) year, males (44%), African Americans (47.6%). The most common sites of the primary tumor were sigmoid and cecum (22.4%) each. Adenocarcinoma being the most common pathology. Majority of the patients (86.2%) were found to have T 3 tumors. Of the patients that received chemotherapy (29/44) 66% had an overall survival rate of three years or more, whereas (53/94) 57% of the patients who did not receive chemotherapy had a survival rate of three years or more. The difference of survival rates between the two groups of patients was not statistically significant. Conclusions: The role of chemotherapy in stage II colon ancer is still controversial. There was no significant difference in overall survival between the two groups who did and did not receive chemotherapy; thus more studies are warranted to explore the factors that predict the survival of stage II colon cancer. No significant financial relationships to disclose.

The significance of ascites in patients with pancreatic cancer: A case-control study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 445-445 ◽  
Author(s):  
Bhargavi Pulluri ◽  
Anjaneya Kathait ◽  
Hua-Ling Tsai ◽  
Amanda L. Blackford ◽  
Joseph M. Herman ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Case Control Study ◽  
Case Control ◽  
Disease Stage ◽  
Lymph Node Status ◽  
Poor Prognostic Factor ◽  
Resectable Disease ◽  
Risk Of Death ◽  
Control Study

445 Background: Malignant ascites confers a poor prognosis in patients with metastatic pancreatic cancer (PC). It is unknown if radiographic ascites in patients with localized disease is a poor prognostic factor and if this finding should be sufficient to avoid upfront local therapies. We aimed to evaluate the survival outcomes of patients with PC and ascites. Methods: Retrospective case control study with overall survival as primary outcome. Eighty newly diagnosed PC patients with ascites (case group) and 80 similar controls without ascites were collected.Cases and controls were matched on age, gender, stage, ECOG performance, surgical treatment, lymph node status and margin status. Overall survival was compared between groups with Cox proportional hazards models by stages, and with a gamma frailty term to account for the correlation between matched pairs on entire cohort. Results: The 80 matched cases included 19 with resectable disease, 9 borderline resectable, 22 locally advanced and 31 with metastatic disease. 29 patients underwent pancreaticoduodenectomy. Table 1 summarizes the overall survival. Ascites patients had higher risk of death compared to patients without ascites (conditional hazard ratio = 1.58 (95% CI: 1.11-2.27), p=0.01). Conclusions: PC patients with ascites have poor overall survival compared to patients without ascites. Even in the setting of resectable disease, survival is similar to patients with advanced disease. This data suggest that all patients with ascites regardless of disease stage should be considered for systemic chemotherapy prior to attempting local treatments. [Table: see text]

Does hospital academic status impact colon cancer care value?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 6-6
Author(s):  
Christine Marie Veenstra ◽  
Andrew J Epstein ◽  
Craig Evan Pollack ◽  
Katrina Armstrong
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Cancer Care ◽  
Cost Of Care ◽  
Stage Ii ◽  
Stage Iii ◽  
Academic Status ◽  
Risk Of Death ◽  
Academic Hospitals ◽  
Significant Difference

6 Background: Given the high cost of cancer care, delivery of high-value care is crucial. The effect of hospital academic status on value of care for patients with stage II and III colon cancer is unknown. Methods: SEER-Medicare cohort study of 20,118 patients age 66+ with stage II or III colon cancer diagnosed 2000-2005 and followed through December 31, 2007. Patients were assigned to a treating hospital based on hospital affiliation of the primary oncologist. We constructed Kaplan-Meier curves to assess unadjusted overall survival. We estimated a Cox proportional hazards model to assess adjusted overall survival. To examine associations between hospital academic status and mean cost of care we estimated a generalized linear model (GLM) with log link and gamma family. We estimated quantile regression models to examine associations between hospital teaching status and cost at various quantiles (25th, 50th, 75th, 90th, 95th, 99th, 99.5th, 99.9th). Standard errors were adjusted to account for clustering of patients within hospitals. Results: 4449/20,118 (22%) patients received care from providers affiliated with academic hospitals. There was no significant difference in unadjusted median survival based on hospital academic status for patients with stage II (academic 6.4 yrs vs. non-academic 6.3 yrs, p=0.711) or stage III disease (academic 4.2 yrs vs. non-academic 4.2 yrs, p=0.81). After adjustment, treatment at academic hospitals was not associated with significantly reduced risk of death from colon cancer (stage II HR 1.05, 95% CI: 0.97 - 1.13; p=0.23; stage III HR 0.99, 95% CI: 0.94-1.07; p=0.98). Excepting stage III patients at the 99.9th percentile of costs, there were no significant differences in adjusted costs between academic and non-academic hospitals. Conclusions: We find no difference in overall survival for patients with stage II or stage III colon cancer based on academic status of the treating hospital. Furthermore, costs of care are similar between academic and non-academic hospitals across virtually the full range of the cost distribution. Most colon cancer patients do not receive cancer care at academic hospitals. Our findings indicate that for patients with stage II or III disease, this inequity does not impact the value of care.

scholarly journals Influence of marital status on overall survival in adult patients with chordoma: A SEER-based study

2020 ◽  
Author(s):  
Chao Tang ◽  
Ruiliang Wang ◽  
Qingguo Lu ◽  
Shantao Wang ◽  
Gen Jia ◽  
...  
Keyword(s):  
Overall Survival ◽  
Marital Status ◽  
Cox Regression ◽  
Bone Tumour ◽  
Prognostic Indicator ◽  
Primary Site ◽  
Adult Patients ◽  
Disease Stage ◽  
Rank Test ◽  
Risk Of Death

Abstract Background. As a rare primary bone tumour, no studies have reported the relationship between prognosis and marital status in patients with chordoma.Methods. We classified patients with chordoma identified from the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2016 into four groups: married, divorced/separated, widowed and single groups. Kaplan-Meier curves with log-rank test and Cox regression were used to analyse the effect of marital status on overall survival (OS).Results. A total of 1,080 patients were included in the study: 700 (64.8%) were married, 88 (8.1%) were divorced/separated, 78 (7.2%) were widowed, and 214 (19.8%) were single. Among the four groups, the 5-year OS (45.2%), 10-year OS (12.5%) and median OS (56.0 months) were the lowest in the widowed group. After including age, sex, primary site, marital status, disease stage, tumor size, histological type, and treatment pattern, multivariate analysis showed that marital status was still an independent risk factor for patients with chordoma, and widowed patients had the lowest OS (hazard ratio [HR]: 1.71; 95% confidence interval [CI]: 1.25–2.33, p<0.001) compared with married patients. Similar results were observed after stratifying the primary site and disease stage.Conclusion. Marital status was an independent prognostic indicator for adult patients with chordoma, and marital status was conducive to patient survival. Compared with married patients, widowed patients have a higher risk of death.

scholarly journals Clinical features and outcomes of COVID-19 among people living with HIV in the United States: A multicenter study from a large global health research network (TriNetX)

2021 ◽  
Author(s):  
George A Yendewa ◽  
Jaime Abraham Perez ◽  
Kayla Schlick ◽  
Heather Tribout ◽  
Grace A McComsey
Keyword(s):  
Mechanical Ventilation ◽  
African American ◽  
Severe Disease ◽  
The United States ◽  
Adverse Outcomes ◽  
Older Age ◽  
Cd4 Count ◽  
Research Network ◽  
People Living With Hiv ◽  
Risk Of Death

Abstract Background HIV infection is a presumed risk factor for severe COVID-19, yet little is known about COVID-19 outcomes in people with HIV (PLW). Methods We used the TriNetX database to compare COVID-19 outcomes of PWH and HIV negative controls aged ≥ 18 years who sought care in 44 healthcare centers in the US from January 1 to December 1, 2020. Outcomes of interest were rates of hospitalization (composite of inpatient non-intensive care (ICU) and ICU admissions), mechanical ventilation, severe disease (ICU admission or death) and 30-day mortality. Results Of 297,194 confirmed COVID-19 cases, 1638 (0.6%) were HIV-infected, with &gt; 83% on antiretroviral therapy (ART) and 48% virally suppressed. Overall, PWH were more commonly younger, male, African American or Hispanic, had more comorbidities, were more symptomatic, and had elevated procalcitonin and interleukin 6. Mortality at 30 days was comparable between the two groups (2.9% vs 2.3%; p=0.123); however, PWH had higher rates hospitalization (16.5% vs 7.6%, p&lt;0.001), ICU admissions (4.2% vs 2.3%, p&lt;0.001) and mechanical ventilation (2.4% vs 1.6%, p&lt;0.005). Among PWH, hospitalization was independently associated with male gender, being African American, integrase inhibitor use and low CD4 count; whereas severe disease was predicted by older age [adjusted odds ratio (aOR) 8.33, 95% confidence interval (CI) (1.06, 50.00); p=0.044] and CD4 &lt;200 cells/mm 3 [aOR, 8.33, 95% CI (1.06, 50.00); p=0.044]. Conclusion PWH had higher rates of poor COVID-19 outcomes but were not more at risk of death than non-HIV infected counterparts. Older age and low CD4 count predicted adverse outcomes.

scholarly journals SURVIVAL OF PATIENTS WITH COLORECTAL CANCER IN A CANCER CENTER

2020 ◽  
Vol 57 (2) ◽  
pp. 172-177
Author(s):  
Samuel AGUIAR JUNIOR ◽  
Max Moura de OLIVEIRA ◽  
Diego Rodrigues Mendonça e SILVA ◽  
Celso Abdon Lopes de MELLO ◽  
Vinicius Fernando CALSAVARA ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cox Regression ◽  
Early Stage ◽  
Age Groups ◽  
Rectal Adenocarcinoma ◽  
Disease Stage ◽  
Cancer Center ◽  
Risk Of Death

ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

scholarly journals Bcl-xL as a poor prognostic biomarker and predictor of response to adjuvant chemotherapy specifically in BRAF-mutant stage II and III colon cancer

2017 ◽  
Author(s):  
Philip D. Dunne ◽  
Helen G. Coleman ◽  
Peter Bankhead ◽  
Matthew Alderdice ◽  
Ronan T. Gray ◽  
...  
Keyword(s):  
Gene Expression ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Protein Expression ◽  
Stage Ii ◽  
Disease Stage ◽  
List Type ◽  
Risk Of Death ◽  
Increased Risk ◽  
Risk Of Relapse

AbstractBackgroundBRAF mutation occurs in 8-15% of colon cancers (CC), and is associated with poor prognosis in metastatic disease. Compared to wild-type BRAF (BRAFWT) disease, stage II/III CC patients with BRAF mutant (BRAFMT) tumors have shorter overall survival after relapse; however, time-to-relapse is not significantly different. The aim of this investigation was to identify, and validate, novel predictors of relapse of stage II/III BRAFMT CC.Patients and methodsWe used gene expression data from a cohort of 460 patients (GSE39582) to perform a supervised classification analysis based on risk-of-relapse within BRAFMT stage II/III CC, to identify transcriptomic biomarkers associated with prognosis within this genotype. These findings were validated using immunohistochemistry in an independent population-based cohort of Stage II/III CC (n=691), applying Cox proportional hazards analysis to determine associations with survival.ResultsHigh gene expression levels of Bcl-xL, a key regulator of apoptosis, were associated with increased risk of relapse, specifically in BRAFMT tumors (HR=8.3, 95% CI 1.7-41.7), but not KRASMT/BRAFWT or KRASWT/BRAFWT tumors. High Bcl-xL protein expression in BRAFMT, untreated, stage II/III CC was confirmed to be associated with an increased risk of death in an independent cohort (HR=12.13, 95% CI 2.49-59.13). Additionally, BRAFMT tumors with high levels of Bcl-xL protein expression appeared to benefit from adjuvant chemotherapy (P for interaction =0.006), indicating the potential predictive value of Bcl-xL expression in this setting.ConclusionsThese findings provide evidence that Bcl-xL gene and/or protein expression identifies a poor prognostic subgroup of BRAFMT stage II/III CC patients, who may benefit from adjuvant chemotherapy.Key MessageUsing a combination of computational biology discovery and immunohistochemistry validation in independent patient cohorts, we show that high expression of the apoptosis regulator Bcl-xL is associated with disease relapse specifically within BRAF mutant stage II/III colon cancer.This data could enable tailored disease management to reduce relapse rates in the most aggressive subtype.

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