Time to surgery (TTS) in renal cell carcinoma (RCC): Predictors and association with overall survival (OS).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16107-e16107
Author(s):  
Anuhya Kommalapati ◽  
Sri Harsha Tella ◽  
Pavankumar Tandra
Keyword(s):  
Surgical Resection ◽  
Primary Tumor ◽  
Private Insurance ◽  
Preoperative Evaluation ◽  
Time Frame ◽  
Lower Grade ◽  
Related Factors ◽  
Cancer Data ◽  
Factors Associated ◽  
Risk Of Death

e16107 Background: Guidelines recommend surgical resection of primary tumor in stages 1-3 RCC. TTS refers to the time frame from the initial diagnosis to surgical resection of primary tumor. Shorter TTS has shown OS benefit in breast, head and neck cancers whereas longer TSS was shown to be acceptable in colon cancer. However, no such data exists for RCC. Using National Cancer Data Base (NCDB), we sought to determine the factors associated with TTS and its effect on OS. Methods: Patients with RCC who underwent partial or total nephrectomy were included, excluding those received neoadjuvant therapy. Logistic regression model was utilized to evaluate relative risk of delayed TTS. OS in association with TTS was estimated using the Kaplan-Meier method and Cox multivariate analysis (MVA). Results: A total of 60,198 RCC patients met the inclusion criteria. In contrast to a prior study that showed a median TTS of 41 days our study showed a median TTS of 35 days. We dichotomized the TTS as ≤ 35 days or ≥ 36 days. On MVA, TSS ≥ 36 days had significantly better OS (HR: 0.95 [CI:0.92-0.99], p < 0.01). Factors associated with TSS ≥ 36 days were race, insurance, higher Charlson score, lower grade, and getting managed at academic facilities and Pacific region (p < 0.01) (Table). Conclusions: A longer TTS with RCC is understandably associated with greater comorbidity, and non-private insurance, but questionably so in race, ethnicity, and facility related factors. However, given that TTS ≥ 36 days was not associated with higher risk of death, it may indicate that a reasonable delay could be pursued in certain cases for more accurate preoperative evaluation. [Table: see text]

Room for improvement? The adoption of multimodal esophageal cancer care in the United States.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 78-78
Author(s):  
R. P. Merkow ◽  
K. Y. Bilimoria ◽  
M. McCarter ◽  
A. Stewart ◽  
W. B. Chow ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Tumor Size ◽  
Locally Advanced ◽  
The United States ◽  
Stage I ◽  
Stage Ii ◽  
Cancer Data ◽  
Factors Associated

78 Background: Consensus guidelines recommend neoadjuvant chemo- or chemoradiation therapy as the preferred treatment for locally advanced esophageal adenocarcinoma; however, it is unknown if this recommendation has been widely adopted in the U.S. Our objective was to examine esophageal cancer multimodal therapy and identify factors associated with the use of neoadjuvant therapy. Methods: From the National Cancer Data Base, patients with middle third, lower third and GE junction (GEJ) adenocarcinomas were identified. Patients who were clinical stage I-III and underwent surgical resection were included. Separate logistic regression models were developed to identify predictors of neoadjuvant therapy utilization and outcomes. Results: From 1998 to 2007, 8,051 patients underwent surgical resection for esophageal cancer: 16.3% stage I, 45.0% stage II and 38.7% stage III. For stage II/III tumors, neoadjuvant use increased (49.0% to 77.8%, p<0.001). After adjustment, factors associated with underuse of neoadjuvant therapy in stage II/III patients were older age, Black or Hispanic ethnicity, more severe comorbidities, tumor location (GEJ and middle vs. lower third), tumor size ≥ 2cm, stage II (vs. III) and geographic region. Stage II/III patients not receiving neoadjuvant had an over two fold increased risk of positive lymph nodes (OR 2.14. 95% CI 1.79 – 2.55, p<0.001). In addition, the positive surgical margin rate increased almost three fold (OR 2.80 95% CI 2.17-3.62, p<0.001) but 30-day postoperative mortality risk was not significantly affected (OR 1.50 95% CI 0.94-2.39; p=0.090). For stage I patients, neoadjuvant therapy decreased over time (38.0% to 11.4%, p<0.001). The overuse of neoadjuvant therapy was associated with higher tumor grade, larger tumor size, and low surgical case volume (all p<0.05). Conclusions: The adoption of neoadjuvant therapy has increased in the past decade; however, opportunity exists to improve guideline treatment for locally advanced esophageal cancer. Registry-based feedback to individual hospitals, such as benchmark comparison tools, could help institutions provide care in concordance with national guidelines. No significant financial relationships to disclose.

Prognostic impact of baseline CEA level and surgery of primary tumor among patients with stage IV denovo colon cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 503-503
Author(s):  
S. S. Dawood ◽  
A. M. Gonzalez-Angulo ◽  
C. Eng
Keyword(s):  
Colorectal Cancer ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Large Population ◽  
Stage Iv ◽  
Low Grade ◽  
Prognostic Impact ◽  
Tumor Surgery ◽  
Risk Of Death ◽  
Increased Risk

503 Background: Surgical resection of primary tumor among pts with stageIV denovo colorectal cancer is controversial. Prognostic role of baseline CEA level in the same cohort has yet to be defined. The objective of this study was to determine the prognostic value of CEA and surgical resection of primary tumor among pts with stage IV denovo colorectal cancer in the era of biologic therapy and to determine subgroups with improved survival outcome. Methods: The Surveillance, Epidemiology and End Results Registry was searched to identify patients with stage IV denovo colorectal cancer diagnosed between 2004-2007. Colorectal cancer specific survival (CCS) was estimated using the Kaplan-Meier product limit method. Cox models were fitted to assess the multivariable relationship of various pt and tumor characteristics and CCS. Results: 19,437 pts were identified with stage IV denovo colorectal cancer. Median CCS was 15M. Median CCS among pts with primary tumor removed was 20M vs 8M (primary intact; p<0.001). Median CCS among pts who had elevated vs. non elevated CEA was 14M vs 23M (p<0.0001). Among pts who had primary tumor surgery median CCS among pts who had elevated vs. non elevated CEA was 19M vs 29M (p<0.0001). Among pts who had primary tumor and distant disease surgically removed, the median CCS among pts who had elevated vs. non elevated CEA was 24M vs 35M (p<0.0001). By multivariable analysis, pts with elevated CEA had a 51% increased risk of death from colorectal cancer compared to those with a non elevated CEA level (HR=1.51, 95%CI 1.40-1.65, p<0.0001). Pts who underwent primary tumor surgery had a 33% decreased risk of death from colorectal cancer compared to those who did not (HR=0.67, 95%CI 0.58-0.78, p<0.0001). Other factors significantly associated with a decreased risk of death from colorectal cancer included low grade disease, non visceral metastases, surgical resection of metastases, younger age and white race. Conclusions: In this large population study, elevated baseline CEA level and surgical resection of the primary tumor had a significant impact on survival outcomes. The best prognostic group were those pts with normal baseline CEA level who proceeded to surgical resection for their primary tumor. No significant financial relationships to disclose.

Prognostic factors influencing survival in small bowel neuroendocrine tumors with liver metastasis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15688-e15688
Author(s):  
Nicholas Manguso ◽  
Attiya Harit ◽  
Nicholas N. Nissen ◽  
James Mirocha ◽  
Andrew Eugene Hendifar ◽  
...  
Keyword(s):  
Liver Metastasis ◽  
Small Bowel ◽  
Surgical Resection ◽  
Primary Tumor ◽  
Cox Regression ◽  
Tumor Grade ◽  
Median Number ◽  
Risk Of Death ◽  
Increased Risk ◽  
Complete Surgical Resection

e15688 Background: Management of liver metastasis in patients with small bowel neuroendocrine tumors (SBNET) remains unclear. Complete surgical resection improves long term survival however factors that influence overall prognosis are not clear. Methods: Database review identified 301 patients diagnosed with SBNET from 1990 to 2013. Only patients with known liver metastasis who underwent resection of the primary tumor were included. Outcomes among patients who underwent complete surgical resection, incomplete debulking of liver metastasis, and resection of the primary tumor alone were compared. The Kaplan-Meier method was used for survival estimates and Cox regression was used to identify predictors of death. Results: 111 patients met study criteria. Median age was 59 years (range 16-80); 49% were male. The terminal ileum (47/111, 42%) was the most common primary tumor location. The median number of liver lesions was 8.5 (range 1-31) and median lesions resected was 1 (range 0-31). In addition to resection of the primary tumor, 36 patients (32%) had no liver resection (NR), 41 (36.9%) had complete resection of liver disease (R0) and 34 (30%) had incomplete resection of liver metastasis (R1). 58 patients (36%) had one or more wedge resections, 12 (10.8%) underwent segmentectomy and 5 (4.5%) had a lobectomy. 33 (29.7%) patients underwent post-operative chemoembolization, 25 (22.5%) had radioembolization and 23 (20.7%) had radiofrequency ablation. The R1 group differed from the R0 group in median size of primary tumor (2.5 cm R1 vs 1.6 cm R0, p = 0.05) and median number of positive lymph nodes (5.0 R1 vs 3.0 R0, p = 0.05). The 5-year OS was 80.9%, 81.1% and 100% for NR, R1 and R0 groups respectively (p = 0.01). 10-year OS did not differ between groups (72.8% NR vs 81.1% R1vs 82.5% NR, p = 0.31). Cox regression showed post-operative administration of chemotherapy (HR = 3.68, p < 0.01) and higher tumor grade (HR = 18.4, p = 0.02) increased risk of death. Conclusions: In patients with SBNET with liver metastasis, higher tumor grade and post-operative chemotherapy increased risk of death. However, resection of the primary tumor along with liver metastasis improves the 5-year OS with complete cytoreduction providing the most benefit.

Impact of Hispanic ethnicity on the clinical presentation and survival of esophageal and gastric cancer in south Florida.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 125-125
Author(s):  
Sofia Palacio ◽  
Daniel A. Sussman ◽  
Bach Ardalan ◽  
Caio Max S. Rocha Lima ◽  
Peter Joel Hosein
Keyword(s):  
Gastric Cancer ◽  
African Americans ◽  
Surgical Resection ◽  
Survival Data ◽  
Race And Ethnicity ◽  
Clinical Presentation ◽  
Private Insurance ◽  
South Florida ◽  
Cox Proportional Hazards Model ◽  
Cancer Data

125 Background: Race and ethnicity are associated with differences in survival among patients with esophageal and gastric cancer (EGC); outcomes are better in Asian patients but worse for African-Americans compared to Caucasians and Asians. Limited data exist for Hispanics (Hisp) compared to non-Hispanic whites (NHW) or African-Americans (AA). Because of the large Hisp population in South Florida, we compared the clinical presentation and survival of patients with EGC by race and ethnicity. Methods: Using a cross-sectional study design, this IRB-approved analysis of the Florida Cancer Data System database identified all patients diagnosed at the University of Miami and Jackson Memorial Hospital between January 2000 and December 2012 with squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the esophagus, and adenocarcinomas of the gastro-esophageal junction (GEJ) or stomach (STO). Demographic, treatment and survival data were extracted from the registry. Survival was analyzed using the Kaplan-Meier method and variables associated with survival were analyzed using a Cox proportional hazards model. Results: Data from 2,170 patients were available; 44% were Hisp, 19% AA and 38% NHW. Compared to NHW's and AA's, Hisp's were more likely to have the following features: male gender, advanced age at cancer diagnosis, esophageal site of malignancy, adenocarcinoma histology, earlier stage at presentation, history of smoking and alcohol use, private insurance, surgical resection and receipt of chemotherapy (p < 0.001 in each case). Hisp were less likely to have STO (p<0.001). In a multivariate model, race and ethnicity were not independently associated with survival but age, stage, surgical resection and chemotherapy administration were all independently associated with survival (p < 0.01 in each case). Country of birth did not influence results among Hispanic patients. Conclusions: Race and ethnicity were not independently associated with survival in this large registry study. However, significant differences in the tumor location, histology and stage of presentation exist, and further studies to elucidate the biological or environmental reasons for these disparities are warranted.

Impact of insurance status on treatment for stage 0-IV breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6532-6532 ◽  
Author(s):  
Rachel Adams Greenup ◽  
Samantha Marie Thomas ◽  
Oluwadamilola Motunrayo Fayanju ◽  
Terry Hyslop ◽  
Eun-Sil Shelley Hwang
Keyword(s):  
Breast Cancer ◽  
Private Insurance ◽  
Cox Proportional Hazards Model ◽  
Oncologic Outcomes ◽  
Bilateral Mastectomy ◽  
Insurance Status ◽  
Cancer Data ◽  
Risk Of Death ◽  
Stage 1 ◽  
Privately Insured

6532 Background: Health insurance can influence utilization of cancer care. We sought to determine whether insurance status impacts treatment patterns and survival in women with stage 0-IV breast cancer. Methods: Women ages 18-69 years old, diagnosed with unilateral stage 0-IV breast cancer between 2004 and 2014 were selected from the National Cancer Data Base. Insurance status was categorized as Private, Medicare (65+ yo), Medicare (18-64 yo), Medicaid, or Uninsured. After adjustment for known covariates, generalized and binary logistic regression were used to estimate the association of insurance type with receipt of treatment. A multivariate Cox proportional hazards model was used to estimate the association of insurance status with overall survival. Results: A total of 610,450 women met inclusion criteria. Median age was 56 (48-63). Insurance status included: 72.1% Privately insured, 13.9% Medicare 65+, 4.8% Medicare 18-64, 7.1% Medicaid, and 2.1% Uninsured. Women with private insurance were more likely to present with stage 1 breast cancer, and less likely to present with stage 4 disease when compared to Medicaid or Uninsured patients (stage 1: 63.4%, 49.4%, 48.2%, p < 0.01; stage IV: 0.8%, 1.8%, 2.1%, p < 0.01). Risk of death was higher in uninsured or Medicaid patients when compared to those with private insurance (HR 1.52, 95% CI 1.41-1.64; HR 1.6, 95% CI 1.52-1.68). Receipt of chemotherapy and radiation did not differ between Medicaid, Uninsured, or Privately insured patients, but women without private insurance were more likely to receive neoadjuvant chemotherapy (OR 1.14, 95% CI 1.09-1.19; OR 1.16, 95% CI 1.07-1.25, respectively, p < 0.01). Uninsured women were more likely to undergo mastectomy without reconstruction (OR 1.57, 95% CI 1.49-1.65), and less likely to undergo unilateral or bilateral mastectomy with reconstruction than lumpectomy and radiation (OR 0.57, 95% CI 0.53-0.61; OR 0.35, 95% CI 0.32-0.39). Conclusions: Stage at diagnosis and risk of death were higher in Medicaid and uninsured breast cancer patients when compared to those with private insurance. Insurance status did not predict differences in receipt of surgery, chemotherapy, or radiation but did affect oncologic outcomes.

Insurance Status, Comorbidity Level, and Survival Among Colorectal Cancer Patients Age 18 to 64 Years in the National Cancer Data Base From 2003 to 2005

2009 ◽  
Vol 27 (22) ◽  
pp. 3627-3633 ◽  
Author(s):  
Anthony S. Robbins ◽  
Alexandre L. Pavluck ◽  
Stacey A. Fedewa ◽  
Amy Y. Chen ◽  
Elizabeth M. Ward
Keyword(s):  
Colorectal Cancer ◽  
Data Base ◽  
Strong Predictor ◽  
Private Insurance ◽  
National Cancer Data Base ◽  
Cox Proportional Hazards ◽  
Insurance Status ◽  
Cancer Data ◽  
Risk Of Death ◽  
Black Patients

Purpose Previous analyses have found that insurance status is a strong predictor of survival among patients with colorectal cancer aged 18 to 64 years. We investigated whether differences in comorbidity level may account in part for the association between insurance status and survival. Methods We used 2003 to 2005 data from the National Cancer Data Base, a national hospital-based cancer registry, to examine the relationship between baseline characteristics and overall survival at 1 year among 64,304 white and black patients with colorectal cancer. In race-specific analyses, we used Cox proportional hazards models to assess 1-year survival by insurance status, controlling first for age, stage, facility type, and neighborhood education level and income, and then further controlling for comorbidity level. Results Comorbidity level was lowest among those with private insurance, higher for those who were uninsured or insured by Medicaid, and highest for those insured by Medicare. Survival at 1 year was significantly poorer for patients without private insurance, even after adjusting for important covariates. In these multivariate models, risk of death at 1 year was approximately 50% to 90% higher for white and black patients without private insurance. Further adjustment for number of comorbidities had only a modest impact on the association between insurance status and survival. In multivariate analyses, patients with ≥ three comorbid conditions had approximately 40% to 50% higher risk of death at 1 year. Conclusion Among white and black patients aged 18 to 64 years, differences in comorbidity level do not account for the association between insurance status and survival in patients with colorectal cancer.

Pelvic radiotherapy in combination with radical resection of the primary tumor improves survival in patients with metastatic rectal adenocarcinoma: A national cancer database analysis (NCDB).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 714-714
Author(s):  
Paul B. Renz ◽  
Shaakir Hasan ◽  
Rodney E Wegner ◽  
Gene Grant Finley ◽  
Dulabh K. Monga ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Rectal Adenocarcinoma ◽  
Primary Tumor Resection ◽  
Pelvic Radiotherapy ◽  
Risk Of Death ◽  
Metastatic Setting

714 Background: With recent advances in systemic therapies and increased survival of patients with metastatic rectal cancer, the role of primary tumor resection may be of increased importance and is often debated. However, the role of combining radiotherapy to surgical resection in the metastatic setting is unknown. Accordingly, we utilized the NCDB to quantify survival in metastatic rectal adenocarcinoma patients with primary tumor resection with and without pelvic radiotherapy. Methods: Of the 15,643 Stage IV rectal adenocarcinoma patients receiving chemotherapy from 2004 to 2014, 4051 patients had primary tumor resection with sufficient follow up for analysis. Patients were stratified by receipt of pelvic radiotherapy (n = 1882) or no pelvic radiotherapy (n = 2169). Univariable/multivariable analyses and propensity-adjusted Cox proportional hazard ratios for survival were performed. Results: Median age was 63 years (18-90) with median follow up of 32.3 months (3.02-151.29). There were more patients with T3/T4 disease (69.6% vs 46.5%) or N1 disease (41.5% vs 27.3%) in the surgery plus radiotherapy arm. Metastatic burden was confined to one organ in 40.5% of patients and was equally distributed between radiotherapy and non-radiotherapy groups (OR 0.92; 95%CI 0.81-1.04). Median survival was 46.3 months vs. 35.3 months in favor of adding radiotherapy (p < 0.001). The 2, 5 and 10-year overall survival were 68.4%, 24.8%, and 9.5% for surgical resection alone compared to 77.2%, 39.6%, and 22.3% for surgery + radiotherapy. On multivariable analysis radiotherapy was associated with a statistically significant reduction in the risk of death (HR 0.718; 95% CI 0.661-0.780). This benefit was upheld on propensity matched analysis (HR 0.722; 95% CI 0.0665-0.784). Conclusions: Our study indicates that adding radiotherapy to surgical management of the primary tumor in patients receiving systemic chemotherapy for metastatic rectal adenocarcinoma improves survival. Prospective investigation of the management of the rectal primary tumor with chemotherapy, pelvic radiotherapy, and surgical resection is warranted.

scholarly journals Factors associated with returning to work after long term absence due to mental disorders

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Päivi Rissanen ◽  
Reija Autio ◽  
Turkka Näppilä ◽  
Sari Fröjd ◽  
Sami Pirkola
Keyword(s):  
Mental Disorder ◽  
Return To Work ◽  
Disability Pension ◽  
Lower Grade ◽  
Related Factors ◽  
Permanent Disability ◽  
Factors Associated ◽  
Study Population ◽  
Returning To Work ◽  
First Time

AbstractIf there is a chance for a person’s ability to work to be restored through treatment or rehabilitation, a temporary disability pension may be granted in Finland. We examined the personal, socio-economic and healthcare-related factors associated with return to work (RTW) after the receipt of temporary disability pension. The study material contains comprehensive register data of individuals who were granted a temporary disability pension due to a mental disorder (ICD10: F10–F69, F80–F99) for the first time between 2010 and 2012 (N = 8615). We applied clustering analysis in order to reveal different patterns of returning to work after receipt of temporary disability pension and utilized multinominal regression analysis to examine gender-specific determinants for RTW and partial RTW in a controlled setting. Being a lower-grade employee remarkably promoted RTW for women (OR 7.85 95% CI 5.35–11.51), as did being a manual worker for men (OR 5.47 95% CI 3.48–8.78). Moreover, both active male (OR 3.51 95% CI 2.19–5.61) and female manual workers (OR 2.44 95% CI 1.66–3.59) had a higher probability of partial RTW compared to people who were initially unemployed. In addition, psychotherapy and vocational rehabilitation were associated with an increased probability of RTW. After 3 years from the initial temporary pensioning, almost two-thirds of the study population (69% of men and 64% of women) still had a temporary or by then a permanent disability pension due to a mental disorder. This and further research could improve the ability to recognize those subjects more likely to return to work than others.

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