Impact of cardiac comorbidity on use and outcomes of adjuvant chemotherapy (ADJ) for colorectal cancer (CRC): A real-world population-based study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 491-491
Author(s):  
Shiru Lucy Liu ◽  
Sharlene Gill ◽  
Winson Y. Cheung
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Population Based ◽  
World Population ◽  
Cancer Specific Survival ◽  
Population Based Study ◽  
Kaplan Meier ◽  
Comorbidity Index ◽  
Resected Stage ◽  
Cardiac Comorbidity

491 Background: Cardiac comorbidities such as myocardial infarction (MI) and congestive heart failure (CHF) may pose challenges in the treatment of CRC. As the population ages, cancer patients (pts) will be increasingly affected by cardiac comorbidities. We performed a population-based analysis of CRC to evaluate the prevalence of MI and CHF, use of ADJ, and survival outcomes. Methods: We evaluated 8601 pts diagnosed with resected stage 2 or 3 CRC from 2004 to 2015 in Alberta, Canada. Baseline patient, tumor, and treatment characteristics were compared between those with and without MI or CHF. Survival analysis was conducted using Kaplan-Meier methods and Cox regression models. Results: In total, 506 (5.9%) patients (pts) had MI and 440 (5.1%) had CHF. CRC patients with prior MI or CHF were older (median 76 and 79 years, respectively) and had worse Charlson Comorbidity Index (median CCI 2 for both) than those without cardiac comorbidities (median age 67 and CCI 0) (p < 0.001). Only 24% and 15% of pts with a MI or CHF history, respectively, received ADJ when compared to their counterparts (52% and 53%, respectively, p < 0.001). Among those who received ADJ (N = 3409), an oxaliplatin-based regimen was used in 26% of MI pts versus 42% of those without MI (p = 0.002), and in 31% of CHF pts versus 42% of those without CHF. Kaplan-Meier analysis revealed significantly worse overall survival (OS) in pts with prior MI (9.1 vs 4.3 years, p < 0.001) or CHF (9.2 vs. 2.7 years, p < 0.001) when compared to those without. However, cancer-specific survival (CSS) was not statistically different with or without MI (p = 0.348) and with or without CHF (p = 0.611). In Cox regression that adjusted for use of ADJ, MI was no longer a significant predictor of OS (HR = 1.01, 95% confidence interval (CI) 0.88-1.15), but CHF remained significant (HR 0.65, 95% CI 0.57-0.74). Neither MI nor CHF were predictors of CSS (HR 1.09, 95% CI 0.98-1.33, and HR 0.94, 95% CI 0.77-1.15). Conclusions: CRC pts with MI or CHF experienced lower use of ADJ and worse OS, but no difference in CSS was observed. ADJ-treated pts with prior MI appeared to benefit while worse outcomes in pts with prior CHF appear to be driven by non-cancer related causes.

Analysis of clinical characteristics and prognosis with cervical adenosquamous carcinoma: a large population-based study

2021 ◽  
Author(s):  
Yanan Ma ◽  
Aimei Zhao ◽  
Jinjuan Zhang ◽  
Sumei Wang ◽  
Jiandong Zhang
Keyword(s):  
Overall Survival ◽  
Regression Models ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Adenosquamous Carcinoma ◽  
Large Population ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Population Based Study ◽  
Good Consistency

Objective: The target of this work was to analyze the clinical characteristics and construct nomograms to predict prognosis in patients with cervical adenosquamous carcinoma (ASC). Methods: A total of 788 ASC patients were tracked in the Surveillance, Epidemiology and End Results database. We compared the clinical characteristics and prognostic factors of ASC. Cox regression models were established, and nomograms constructed and verified. Results: ASC patients have lower age levels and higher histological grades than patients with squamous cell carcinoma. Nomograms were constructed with good consistency and feasibility in clinical practice. The C-indices for overall survival and cancer-specific survival were 0.783 and 0.787, respectively. Conclusion: ASC patients have unique clinicopathological and prognostic characteristics. Nomograms were successfully constructed and verified.

scholarly journals Comorbidities and malignancies negatively affect survival in myelodysplastic syndromes: a population-based study

2021 ◽  
Vol 5 (5) ◽  
pp. 1344-1351
Author(s):  
Johanne Rozema ◽  
Mels Hoogendoorn ◽  
Robby Kibbelaar ◽  
Eva van den Berg ◽  
Nic Veeger ◽  
...  
Keyword(s):  
Cox Regression ◽  
De Novo ◽  
Previous Treatment ◽  
Patient Characteristics ◽  
Population Based ◽  
Population Based Study ◽  
Health Records ◽  
Kaplan Meier ◽  
Comorbidity Index ◽  
Survival Differences

Abstract Population-based studies that contain detailed clinical data on patients with myelodysplastic syndrome (MDS) are scarce. This study focused on the real-world overall survival (OS) of MDS patients in association with comorbidities, specifically malignancies. An observational population-based study using the HemoBase registry was performed, including all patients with MDS diagnosed between 2005 and 2017 in Friesland, a Dutch province. Detailed information about diagnosis, patient characteristics, previous treatment of malignancies, and comorbidities according to the Charlson Comorbidity Index (CCI) was collected from electronic health records. Patients were followed up until June 2019. Kaplan-Meier plots and Cox regression analyses were used to study survival differences. In the 291 patients diagnosed with MDS, the median OS was 25.3 months (95% confidence interval [CI], 20.3-30.2). OS was significantly better for patients with CCI score &lt;4, age &lt;65 years, female sex, and low-risk MDS. Fifty-seven patients (20%) had encountered a prior malignancy (excluding nonmelanoma skin cancer), and a majority (38 patients; 67%) were therapy related. Both therapy-related and secondary MDSs were associated with worse OS (hazard ratio, 1.51; 95% CI, 1.02-2.23 and 1.58; 95% CI, 0.95-2.65, respectively), as compared with de novo MDS patients (P = .04). Patients in remission at time of MDS diagnosis had a similar median OS compared with patients with de novo MDS (25.5 vs 28.3 months). This population-based study involving all newly diagnosed MDS patients over a 13-year period in Friesland showed that multiple comorbidities, including previous malignancies, are associated with shorter OS. OS was not related to the use of radiotherapy or chemotherapy.

Natural history and outcomes of synchronous and metachronous colorectal cancers (CRC): A population-based analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3593-3593
Author(s):  
Jackson Chu ◽  
Ozge Goktepe ◽  
Winson Y. Cheung
Keyword(s):  
Cox Regression ◽  
Large Population ◽  
Population Based ◽  
Survival Outcomes ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Presenting Symptoms ◽  
Kaplan Meier ◽  
Index Cancer ◽  
Metachronous Tumors

3593 Background: Early data suggest that synchronous and metachronous CRC portend a worse prognosis when compared to solitary CRC. Our aims were to 1) characterize the clinical features and treatment patterns of synchronous and metachronous CRC and 2) compare their survival outcomes with those of solitary CRC. Methods: All patients diagnosed with non-metastatic CRC between 1999 and 2008 and referred to any 1 of 5 regional cancer centers in British Columbia, Canada were reviewed. Synchronous and metachronous CRC were defined as multiple (2 or more) distinct tumors that were diagnosed within and beyond 6 months of the date of index CRC diagnosis, respectively, during the study period. Patients with liver metastases at initial diagnosis were excluded. Kaplan-Meier and Cox regression analyses were used to estimate survival among the different CRC groups. Results: A total of 6360 patients were identified: 6147 (96%) solitary, 178 (3%) synchronous and 35 (1%) metachronous tumors; median age was 68 years (IQR 59-76); 57% were men; and 75% were ECOG 0/1 at the time of index cancer diagnosis. Baseline demographic characteristics were comparable across patients (all p>0.05). Compared with solitary CRC, synchronous and metachronous CRC more commonly affected the colon rather than the rectum (84 vs 85 vs 59%, respectively, p<0.001), but presenting symptoms, treatment approaches, and use of chemotherapy, radiation and surgery were similar among the different tumor groups (all p>0.05). In terms of survival, no differences were observed in 3-year relapse free survival (66 vs 66 vs 56%, p=0.20), 5-year cancer specific survival (69 vs 69 vs 53%, p=0.34) and 5-year overall survival (62 vs 59 vs 49%, p=0.74) for solitary, synchronous and metachronous CRC, respectively. These findings persisted after controlling for known prognostic factors, such as age and ECOG. Conclusions: In this large population-based cohort, there were no differences in survival outcomes among solitary, synchronous and metachronous CRC. Patients who present with multiple tumors in the colon or the rectum should be managed similarly to those who present with an isolated tumor.

scholarly journals Conditional Survival After Surgical Resection of Appendiceal Tumors: a Population-based Study

2021 ◽  
Author(s):  
Shutao Zhao ◽  
Chang Lu ◽  
Junan Li ◽  
Chao Zhang ◽  
Xudong Wang
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Population Based ◽  
Conditional Survival ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Population Based Study ◽  
Factors Affecting ◽  
Probability Of Survival ◽  
N Stage

Abstract Background: This study aimed to evaluate the conditional survival (CS) of appendiceal tumors (ATs) after surgery.Methods: A total of 3,031 patients with ATs who underwent surgery were included in the Surveillance Epidemiology and End Results (SEER) database from 2004 to 2016. A multivariate Cox regression model was used to analyze the prognostic factors affecting overall survival (OS) and cancer-specific survival (CSS). CS was used to calculate the probability of survival for another 3 years after the patient had survived x years. The formulas were COS3 = OS (x + 3) /OS (x), and CCS3 = CSS (x + 3)/CSS (x).Results: The 1-year, 3-year, and 5-year OSs for all patients were 95.6%, 83.3%, and 73.9%, respectively, while the 1-year, 3-year, and 5-year CSSs were 97.0%, 87.1%, and 79.9%, respectively. Age, grade, histology, N stage, carcinoembryonic antigen (CEA), and radiation were independent prognostic factors for OS and CSS. For patients that survived for 1 year, 3 years, and 5 years, their COS3s were 81.7%, 83.9%, and 87.0%, respectively. The CCS3s were 85.5%, 88.3%, and 92.0% respectively. In patients with poor clinicopathological factors, COS3 and CCS3 increased significantly, and the survival gap between OS and COS3, CSS and CCS3 was more obvious.Conclusions: CS for appendiceal tumors were dynamic and increased over time, especially in patients with poor prognosis.

scholarly journals Impact of gender on the survival of patients with glioblastoma

2018 ◽  
Vol 38 (6) ◽  
Author(s):  
Minjie Tian ◽  
Wenying Ma ◽  
Yueqiu Chen ◽  
Yue Yu ◽  
Donglin Zhu ◽  
...  
Keyword(s):  
Sex Hormones ◽  
Survival Data ◽  
Cox Regression ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Kaplan Meier ◽  
Male Patients ◽  
Stratified Analysis ◽  
The Impact

Background: Preclinical models have suggested a role for sex hormones in the development of glioblastoma multiforme (GBM). However, the impact of gender on the survival time of patients with GBM has not been fully understood. The objective of the present study was to clarify the association between gender and survival of patients with GBM by analyzing population-based data. Methods: We searched the Surveillance, Epidemiology, and End-Results database who were diagnosed with GBM between 2000 and 2008 and were treated with surgery. Five-year cancer specific survival data were obtained. Kaplan–Meier methods and multivariable Cox regression models were used to analyze long-term survival outcomes and risk factors. Results: A total of 6586 patients were identified; 61.5% were men and 38.5% were women. The 5-year cancer-specific survival (CSS) rates in the male and female groups were 6.8% and 8.3%, respectively (P=0.002 by univariate and P<0.001 by multivariate analysis). A stratified analysis showed that male patients always had the lowest CSS rate across localized cancer stage and different age subgroups. Conclusions: Gender has prognostic value for determining GBM risk. The role of sex hormones in the development of GBM warrants further investigation.

scholarly journals Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study

2020 ◽  
Vol 17 (2) ◽  
pp. 568 ◽  
Author(s):  
Bárbara Heather Lutz ◽  
Diego Garcia Bassani ◽  
Vanessa Iribarrem Avena Miranda ◽  
Marysabel Pinto Telis Silveira ◽  
Sotero Serrate Mengue ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Medication Use ◽  
Population Based ◽  
Birth Cohort Study ◽  
Ministry Of Health ◽  
Adverse Side Effects ◽  
Kaplan Meier ◽  
Duration Of Breastfeeding ◽  
Risk Categories

Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale’s lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale’s risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.

Natural history and outcomes in a population-based cohort of synchronous and metachronous colorectal cancers (CRC).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 485-485
Author(s):  
Jackson Chu ◽  
Ozge Goktepe ◽  
Winson Y. Cheung
Keyword(s):  
Cox Regression ◽  
Population Based ◽  
Colorectal Adenomas ◽  
Survival Outcomes ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Bowel Movements ◽  
Metachronous Tumors ◽  
Worse Prognosis

485 Background: Early data suggest that synchronous and metachronous CRC may portend a worse prognosis when compared to solitary CRC. Our study objectives were to 1) characterize the clinical features and treatment patterns of synchronous and metachronous CRC and 2) compare their survival outcomes with those of solitary CRC. Methods: All patients diagnosed with either synchronous or metachronous CRC between 1999 and 2008 and referred to 1 of 5 regional cancer centers in British Columbia were reviewed. Synchronous and metachronous CRC were defined as multiple (2 or more) distinct tumors that were diagnosed within and beyond 6 months of the date of index CRC diagnosis, respectively. Patients with liver metastases at initial diagnosis were excluded. Kaplan-Meier and multivariate Cox regression analyses were used to estimate survival for synchronous and metachronous CRC, and to compare outcomes with solitary CRC. Results: A total of 213 patients with 388 synchronous and 69 metachronous cases of CRC were included: median age was 70 (range 26-94), 55% were men, and 30% were ECOG 0 to 1 at index diagnosis. At initial presentaiton, 35% and 51% of patients who manifested with synchronous and metachronous tumors, respectively, were TNM stage III. Concurrent colorectal adenomas were found in 45% of synchronous and 33% of metachronous cases. The most prevalent symptoms experienced by patients included changes in bowel movements and abdominal pain. The majority of patients underwent a curative resection (99% of synchronous and 97% of metachronous). Adjuvant chemotherapy was used to treat 44% of both synchronous and metachronous tumors. Compared to solitary CRC, patients with synchronous and metachronous CRC had similar 3-year relapse-free survival (66 vs. 66 vs. 56%, p=0.20), 5-year cancer-specific survival (69 vs. 67 vs. 53%, p=0.34), and 5-year overall survival (62 vs. 59 vs. 49%), p=0.74. Similar observations persisted in the multivariate Cox regression model. Conclusions: There appears to be no differences in survival outcomes in patients with solitary, synchronous, or metachronous CRC. Patients who present with multiple CRC tumors should be managed similarly to those who only present with an isolated tumor.

Kleinzelliges Lungenkarzinom: Interdisziplinär für oder wider eine Operation entscheiden

2020 ◽  
Vol 8 (6) ◽  
pp. 322-323
Author(s):  
Khosro Hekmat
Keyword(s):  
Lung Cancer ◽  
Tumor Size ◽  
Cox Regression ◽  
Population Based ◽  
Kleinzelliges Lungenkarzinom ◽  
Matched Cohort ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Patient Groups

<b>Background:</b> The role of surgery for small cell lung cancer (SCLC) is not clear. We aimed to evaluate this issue using a population-based database. <b>Methods:</b> Patients diagnosed between 2004 and 2014 with SCLC staged T1–4 N0–2 M0 disease were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to reduce bias between the surgical and nonsurgical patient groups. The Kaplan-Meier method and Cox regression analysis were used to compare overall survival (OS) for the matched patients. <b>Results:</b> A total of 8,811 patients were retrieved, including 863 patients who underwent surgical resection. After 1: 1 PSM, a matched cohort with 1,562 patients was generated. In the matched cohort, surgery was associated with 5-year OS improvement (from 16.8 to 36.7%, <i>p</i> &#x3c; 0.001) and lung cancer-specific survival improvement (from 21.6 to 43.2%, <i>p</i> &#x3c; 0.001). Survival benefits of surgery were significant in all subgroups, including N1–2 disease, except for patients with a tumor size &#x3e;5.0 cm or T3 disease. <b>Conclusions:</b> Patients with SCLC of limited stage can benefit from surgery, including N1–2 disease. However, patients with a tumor size &#x3e;5.0 cm or advanced T stage may be unable to benefit from surgery.

scholarly journals Prognostic Factors, Survival Analyses and the Risk of Second Primary Cancer: A Population-Based Study on Burkitt Lymphoma/Leukemia

Diseases ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 43
Author(s):  
Ana M. Della Rocca ◽  
Fernanda S. Tonin ◽  
Mariana M. Fachi ◽  
Alexandre F. Cobre ◽  
Vinicius L. Ferreira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Burkitt Lymphoma ◽  
Cox Regression ◽  
Liver Tumors ◽  
Population Based ◽  
Second Primary ◽  
Population Based Study ◽  
Second Primary Cancers ◽  
Kaplan Meier

Burkitt lymphoma/leukemia (BL/L) is an aggressive oncohematological disease. This study evaluated the population-based prognosis and survival on BL/L as well as if BL/L behaved as a risk factor for the development of second primary cancers (SPCs) and if other first tumors behaved as risk factors for the occurrence of BL/L as an SPC. A retrospective cohort using the Surveillance, Epidemiology and End Results (SEER) Program (2008–2016) was performed. Kaplan–Meier, time-dependent covariate Cox regression and Poisson regression models were conducted. Overall, 3094 patients were included (median, 45 years; IQR, 22–62). The estimated overall survival was 65.4 months (95% CI, 63.6–67.3). Significantly more deaths occurred for older patients, black race, disease at an advanced stage, patients without chemotherapy/surgery and patients who underwent radiotherapy. Hodgkin lymphomas (nodal) (RR, 7.6 (3.9–15.0; p < 0.001)), Kaposi sarcomas (34.0 (16.8–68.9; p < 0.001)), liver tumors (3.4 (1.2–9.3; p = 0.020)) and trachea, mediastinum and other respiratory cancers (15.8 (2.2–113.9; p = 0.006)) behaved as risk factors for the occurrence of BL/L as an SPC. BL/L was a risk factor for the occurrence of SPCs as acute myeloid leukemias (4.6 (2.1–10.4; p < 0.001)), Hodgkin lymphomas (extranodal) (74.3 (10.0–549.8; p < 0.001)) and Kaposi sarcomas (35.1 (12.1–101.4; p < 0.001)). These results may assist the development of diagnostic and clinical recommendations for BL/L.

scholarly journals Survival among cancers screened at the first stage of Dispanserization of certain groups of the adult population: a population-based epidemiological analysis

2021 ◽  
Vol 67 (4) ◽  
pp. 501-510
Author(s):  
Ludmila Valkova ◽  
Vakhtang Merabishvili ◽  
Aleksandra Pankratyeva ◽  
Anna Agaeva ◽  
Anton Ryzhov ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cox Model ◽  
Adult Population ◽  
Treatment Method ◽  
Population Based ◽  
Malignant Neoplasms ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Before And After

Objective: to evaluate trends of survival in nine index malignant neoplasms (iMNs), which are screened at the first stage of the Dispanserization of certain groups of the adult population (DCGAP), on data of the Arkhangelsk regional cancer registry over a period 2006-2019. Materials and methods. We compared two seven-year periods 2006-2012 and 2013-2019, before and after the introduction of the DCGAP. The 1- and 5-year cancer-specific survival (CSS) rate was calculated using the life table and Kaplan-Meier methods with an assessment of the differences by log-rank. Cox regression analysis with sequential input was used to identify possible causes of differences in survival between periods and independent prognostic factors. Results. 37197 cases were selected for analysis. 5-year CSS estimates in 2013-2019 compared with the previous seven-year period significantly increased for all nine iMNs, by from 2.5% [2006-2012, 12.5% ​​(95% confidence interval (CI) 11.4-13.6%) vs 2013-2019, 15.0 (95% CI 13.7-16.5%)] in lung cancer up to 12.6% [2006-2012, 31.0% (95% CI 28.6-33.4%) vs 2013-2019, 43.6 (95% CI 40.8-46.2%)]. Correction for the stage (possible effect of screening) in the Cox model has led to a decrease in the hazard ratio (HR) of death from cancer of the colon, rectum, breast, kidney by 38-64%, no change for other iMNs; while for cervical cancer, it has increased. Adjustment for the variable "treatment method" led to a 34-100% decrease in the HR in the Cox model for all iMNs, except for prostate cancer. Conclusion. The increase in survival estimates for nine iMNs in 2013-2019 can be explained to a large extent by improved access to cancer-directed treatment and its quality; the contribution of DCGAP is possible in renal, breast and colorectal cancer. Key words: malignant neoplasms, screening, dispensarization of certain groups of the adult population, survival

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