Survival among breast cancer patients with a history of previous cancer.

e14080 Background: A growing number of women newly diagnosed with breast cancer have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. Among women diagnosed with incident breast cancer, we examined the impact of previous cancer on overall and cancer-specific survival. Methods: This population-based cohort study included patients age ≥66 years and diagnosed with breast cancer between 2005-2015 in linked SEER-Medicare data. Separately by breast cancer stage, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression for women with and without previous cancer, adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident breast cancer. Results: Of 138,576 women diagnosed with incident breast cancer, 10,822 (7.8%) had a previous cancer of another organ site and many of these (n = 5,014, 46.3%) were diagnosed ≤5 years of breast cancer. For all breast cancer stages except IV in which there was no significant survival difference, women with vs. without previous cancer had worse overall survival (see Table). This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, while women with previous cancer generally had favorable breast-cancer specific survival, the impact of previous cancer on this outcome varied over time. Conclusions: Many women newly diagnosed with breast cancer are already cancer survivors. These women have generally worse overall survival, worse survival from other causes, but their disease-specific survival varies depending on their breast cancer stage and over time. Future analyses will explore time-varying effect of previous cancer on breast cancer survival. [Table: see text]

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Survival among colorectal cancer patients with a history of previous cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16146 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16146-e16146

Author(s):

Sandi Pruitt ◽

David E. Gerber ◽

Hong Zhu ◽

Daniel Heitjan ◽

Bhumika Maddineni ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Cox Regression ◽

Population Based ◽

Competing Risk ◽

Cancer Specific Survival ◽

Risk Of Death ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

e16146 Background: A growing number of patients with colorectal cancer (CRC) have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. We examined the impact of previous cancer on overall and cancer-specific survival in a population-based cohort of patients diagnosed with incident CRC. Methods: We identified patients aged ≥66 years and diagnosed with CRC between 2005-2015 in linked SEER-Medicare data. For patients with and without previous cancer, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression, separately by CRC stage, while adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident CRC. Results: Of 112,769 CRC patients diagnosed with incident CRC, 15,935 (14.1%) had a previous cancer – most commonly prostate (32.9%) or breast (19.4%) cancer, with many 7505 (47.1%) diagnosed ≤5 years of CRC. For all CRC stages except IV in which there was no significant difference in survival, patients with previous cancer had modestly worse overall survival (hazard ratios from fully adjusted models range from 1.11-1.28 across stages; see Table). This survival disadvantage was driven by deaths due to previous cancer and other causes. Notably, most patients with previous cancer had improved CRC-specific survival. Conclusions: CRC patients who have survived a previous cancer have generally worse overall survival but superior CRC-specific survival. This evidence should be considered concurrently with concerns about trial generalizability, low accrual, and heterogeneity of participants when determining exclusion criteria. [Table: see text]

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Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.1168 ◽

2008 ◽

Vol 26 (30) ◽

pp. 4891-4898 ◽

Cited By ~ 132

Author(s):

Shaheenah Dawood ◽

Kristine Broglio ◽

Ana M. Gonzalez-Angulo ◽

Aman U. Buzdar ◽

Gabriel N. Hortobagyi ◽

...

Keyword(s):

Breast Cancer ◽

Stage Iv ◽

The United States ◽

Breast Cancer Specific Survival ◽

Newly Diagnosed ◽

Cancer Specific Survival ◽

Risk Of Death ◽

Black Patients ◽

Stage Iv Breast Cancer ◽

White Patients

Purpose Overall, breast cancer mortality has been declining in the United States, but survival studies of patients with stage IV disease are limited. The aim of this study was to evaluate trends in and factors affecting survival in a large population-based cohort of patients with newly diagnosed stage IV breast cancer. Patients and Methods We searched the Surveillance, Epidemiology, and End Results registry to identify female patients with stage IV breast cancer diagnosed between 1988 and 2003. Patients were divided into three groups according to year of diagnosis (1988 to 1993, 1994 to 1998, and 1999 to 2003). Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics independently associated with survival. Results We identified 15,438 patients. Median age was 62 years. Median follow-up was 16 months, 18 months, and 11 months in periods 1988 to 1993, 1994 to 1998, and 1999 to 2003, respectively. Median breast cancer–specific survival was 23 months. In the multivariate model, earlier year of diagnosis, grade 3 disease, increasing age, being unmarried, hormone receptor–negative disease, and no surgery were all independently associated with worse overall and breast cancer–specific survival. With each successive year of diagnosis, black patients had an increasingly greater risk of death compared with white patients (hazard ratio, 1.03; 95% CI, 1.00 to 1.06; P = .031). Conclusion The survival of patients with newly diagnosed stage IV breast cancer has modestly improved over time, but these data suggest that the disparity in survival between black and white patients has increased.

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Incidence of Venous Thromboembolism and the Impact on Survival in Breast Cancer Patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.4393 ◽

2007 ◽

Vol 26 (1) ◽

pp. 70-76 ◽

Cited By ~ 156

Author(s):

Helen K. Chew ◽

Theodore Wun ◽

Danielle J. Harvey ◽

Hong Zhou ◽

Richard H. White

Keyword(s):

Breast Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Metastatic Disease ◽

Cancer Stage ◽

Breast Cancer Patients ◽

Data Set ◽

Discharge Data ◽

Risk Of Death ◽

The Impact

Purpose The incidence of venous thromboembolism (VTE) and the risk factors associated with development of VTE have not been reported in a large population-based study of breast cancer patients. Patients and Methods The California Cancer Registry was merged with the Patient Discharge Data Set, and the number of VTE events determined among patients diagnosed between 1993 and 1999. Results Among 108,255 patients with breast cancer, the 2-year cumulative VTE incidence was 1.2%, with a rate of 1.2 and 0.6 events/100 patient-years during the first and second half-year, respectively. The 1-year incidence of VTE was significantly increased compared with the general population (standardized incidence ratio of VTE, 4.2; 95% CI, 3.9 to 4.4). In a multivariate model, significant predictors of developing VTE within 2 years were: age (hazard ratio [HR], 2.0 if > 75 years v < 45; 95% CI, 1.6 to 2.6), the number of chronic medical comorbidities (HR, 2.9 if 3 v 0; 95% CI, 2.4 to 3.5), and advancing cancer stage (HR, 6.3; 95% CI, 5.3 to 7.5 for metastatic v local disease). In multivariate models, VTE was a significant predictor of decreased 2-year survival (HR, 2.3; 95% CI, 2.1 to 2.6) and when stratified by initial cancer stage, the effect was highest in patients with localized (HR, 5.1; 95% CI, 3.6 to 7.1) or regional stage (HR, 3.5; 95% CI, 2.5 to 4.8) cancer compared with patients with metastatic disease (HR, 1.9; 95% CI, 1.5 to 2.4). Conclusion Approximately 1% of breast cancer patients developed VTE within 2 years, with the highest incidence in the first 6 months after diagnosis. Metastatic disease and comorbidities were the strongest predictors. The diagnosis of VTE was associated with a higher risk of death within 2 years.

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Overall Survival and Cause-Specific Mortality of Patients With Stage T1a,bN0M0 Breast Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.08.0499 ◽

2007 ◽

Vol 25 (31) ◽

pp. 4952-4960 ◽

Cited By ~ 182

Author(s):

Emer O. Hanrahan ◽

Ana M. Gonzalez-Angulo ◽

Sharon H. Giordano ◽

Roman Rouzier ◽

Kristine R. Broglio ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Systemic Therapy ◽

Seer Program ◽

Adjuvant Systemic Therapy ◽

Locoregional Therapy ◽

Breast Cancer Specific Survival ◽

Cancer Specific Survival ◽

The Impact ◽

Related Mortality

Purpose With mammographic screening, the frequency of diagnosis of stage T1a,bN0M0 breast cancer has increased. Prognosis after locoregional therapy and benefit from adjuvant systemic therapy are poorly defined. We reviewed T1a,bN0M0 breast cancer cases registered in the Surveillance, Epidemiology, and End Results (SEER) Program to investigate the impact of prognostic factors on breast cancer–specific (BCSM) and non–breast cancer–related mortality. Methods We identified T1a,bN0M0 breast cancer cases registered in the SEER Program from 1988 to 2001, and used the Kaplan-Meier product limit method to describe overall survival (OS). We estimated the probabilities of death resulting from breast cancer and from other causes, and analyzed associations of patient and tumor characteristics with OS, BCSM, and non–breast cancer–related mortality using the log-rank test, Cox proportional hazards models, and a competing-risk model. We constructed nomograms to assist physicians in adjuvant therapy decision making. Results We identified 51,246 T1a,bN0M0 cases. Median follow-up was 64 months (range, 1 to 167 months). Median age at diagnosis was 65 years (range, 20 to 101 years). Ten-year probabilities of all-cause mortality and BCSM were 24% and 4%, respectively. Characteristics associated with increased probability of BCSM included age younger than 50 years at diagnosis, high tumor grade, estrogen receptor–negative status, progesterone receptor–negative status, and fewer than six nodes removed at axillary dissection. The constructed nomograms allow a comparison of predicted breast cancer–specific survival and non-breast cancer–specific survival in individual patients. Conclusion Overall, the prognosis of patients with T1a,bN0M0 breast cancer is excellent. However, subgroups of patients who are at higher risk of BCSM and who should be considered for adjuvant systemic therapy can be identified.

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Improved Survival for Patients with CLL in the Era of Combination Chemoimmunotherapy - a Danish Population Based Study

Blood ◽

10.1182/blood.v126.23.1740.1740 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1740-1740 ◽

Cited By ~ 2

Author(s):

Caspar da Cunha-Bang ◽

Jacob Simonsen ◽

Klaus Rostgaard ◽

Christian H Geisler ◽

Henrik Hjalgrim ◽

...

Keyword(s):

Overall Survival ◽

Survival Probability ◽

Population Based ◽

Danish Population ◽

Younger Patients ◽

Risk Of Death ◽

Improvement In Survival ◽

The Impact ◽

First Time ◽

Over Time

Abstract Background The treatment of chronic lymphocytic leukemia (CLL) is in rapid transition. As single agents, Fludarabine (F) was shown to be superior to chlorambucil (Rai, NEJM, 2000). Soon after F with Cyclophosphamide (C), showed superiority to F alone (Eichhorst, Blood, 2006; Flinn, JCO, 2007, Catovsky, Lancet, 2007). Subsequently, the addition of CD20 antibody rituximab (R) to FC for the first time showed a survival benefit for fit patients in a clinical trial (Hallek, Lancet, 2010). Likewise, in unfit patients the addition of CD20 antibodies to chlorambucil led to increased overall survival (Goede, NEJM, 2014). Eventually, BCR-targeted treatment for patients harboring TP53 aberrations demonstrated promising results (Farooqui, Lancet Onc, 2015). Here we assess the impact of these successive changes of therapy on the survival of patients with CLL in a Danish population-based cohort. Methods We studied the survival of a population-based cohort of CLL patients reported to the Danish Cancer Registry 1978-2013. Patients were categorized according to year of diagnosis from 1978-1994, 1995-2000, 2001-2005 and 2006-2013. For each CLL patient, we randomly selected 50 controls from the general population matched on age, gender and municipality. Kaplan MeierÕs survival curves and Hazard ratios (HR) and 95% confidence interval (95%CI) for death since time of diagnosis /matching date for controls were calculated. Change in survival probability relative to the controls with stratification on gender, age and calendar period of diagnosis was assessed. Results In total, 10500 patients were diagnosed with CLL in Denmark from 1978 to 2013 as follows: 1978-1994: 4651, 1995-2000: 1622, 2001-2005: 1664 and 2006-2013: 2563. Thus, the reported incidence of CLL increased slightly after year 2000. Overall, we observed a continuously decreasing risk of death for patients with CLL compared to matched controls, with HRs from 3.47 (3.37 - 3.58) to 2.09 (1.96 - 2.24) for patients diagnosed 1978-1994 and 2005-2013, respectively. In inter group analyses, a significant stepwise reduction in risk of death was observed for each period (Figure 1). In all age groups and calendar periods, male patients had an inferior survival compared to female patients and younger patients survived longer than older patients (p<0.0001). Discussion A significant improvement in survival probability for patients with CLL over time was found. This coincides with the introduction of FCR as standard therapy for younger patients with CLL (approval by EMA in 2009, affecting the cohort diagnosed 2006-2013). Significant survival improvement was also observed in the 2001-2005 cohort, possibly due to a shift to combination chemotherapy. Also for elderly patients, otherwise expected to get less intensive treatment in part due to co-morbidities, the survival improved over time. This may be accounted for by the introduction of semi-intensive chemotherapy like bendamustine, reduced intensity FC(R) and more recently chlorambucil combined with CD20-targeting antibodies. For the first time, we here present population-based data showing significant improvement in survival for patients with CLL in parallel with the introduction of new chemo-immunotherapeutic regimens into clinical practice. These data substantiate the reported increased survival for patients treated with chemo-immunotherapy in clinical studies. Further investigation and cross-reference with treatment databases are warranted in order to assess the impact of new targeted treatment options for CLL. Figure 1. Overall survival for patients (70-79 and 50-59 years), lower four curves; upper four curves represent matched controls. Figure 1. Overall survival for patients (70-79 and 50-59 years), lower four curves; upper four curves represent matched controls. Disclosures Geisler: GlaxoSmithKline: Consultancy; Novartis: Consultancy; Janssen: Consultancy; Celgene: Consultancy; Gilead: Consultancy; Roche: Consultancy. Niemann:Novartis: Other: Travel grant; Janssen: Consultancy; Roche: Consultancy; Gilead: Consultancy.

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Elucidating the clinical-pathological factors and prognosis in breast cancer young surviving women who had a subsequent pregnant

International Journal of Biological and Pharmaceutical Sciences Archive ◽

10.53771/ijbpsa.2021.2.2.0090 ◽

2021 ◽

Vol 2 (2) ◽

pp. 013-025

Author(s):

Ramírez-Torres Nicolás ◽

Hernández-Valencia Marcelino ◽

Rivas-Ruíz Rodolfo

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Lymph Nodes ◽

Proportional Hazards ◽

Locally Advanced ◽

Cox Proportional Hazards ◽

Nodal Status ◽

Bivariate Analysis ◽

Risk Of Death ◽

The Impact

Objective. To elucidate the impact of clinical-pathological factors on overall survival (OS) in patients who got pregnant after breast cancer treatment. Methods. Retrospective cohort of women age younger than 40 years with breast cancer history without active disease at diagnosis of postcancer pregnancy. Clinical-pathological factors were analized by age group and recent birth. Overall survival (OS) was evaluated from Kaplan-Meier method. The association between clinical-pathological factors and OS was examined using Cox proportional hazards method to estimate hazard ratio (HR) with 95% confidence intervals (CI). Results: A total of 14 patients were selected. Median age was 28.5 years (interquartile range, 26-35). Locally advanced stage (IIB-IIIB) was diagnosed in 64.3%. Patients lower than 35 years experienced more positive clinical lymph nodes (72.7%), grade 2 (63.6%) and ER/PgR-negative tumors (54.5% and 72.7%, respectively). The patients with ER-positive tumors showed an improvement non-significant at 5-year OS (87%; p = 0.097). In the bivariate analysis, patients with a higher number of pathological lymph nodes (pNs) had a 12% increase in the risk of death than those with lower number (HR = 1.12; 95% CI: 1.02 to 1.2). The multivariate model (after adjustment for number of pNs, age and tumor size) ascertained that the nodal status was the only independent predictor associated to a worse OS (HR = 1.15; 95% CI: 1.01 to 1.3). Conclusion. Pregnancy after cancer did not have a detrimental effect on survival. The patients < 35 years old group showed more unfavorable tumor features at diagnosis, which can largely explain a poorer prognosis. Nodal status was the most important prognostic factor that predicted the poor prognosis.

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Improved survival in multiple myeloma and the impact of novel therapies

Blood ◽

10.1182/blood-2007-10-116129 ◽

2008 ◽

Vol 111 (5) ◽

pp. 2516-2520 ◽

Cited By ~ 1505

Author(s):

Shaji K. Kumar ◽

S. Vincent Rajkumar ◽

Angela Dispenzieri ◽

Martha Q. Lacy ◽

Suzanne R. Hayman ◽

...

Keyword(s):

Overall Survival ◽

Median Overall Survival ◽

High Dose ◽

Novel Therapies ◽

Newly Diagnosed ◽

Single Institution ◽

High Dose Therapy ◽

Trends Over Time ◽

The Impact ◽

Over Time

Treatments for myeloma have expanded in the last decade, but it is not clear if the introduction of novel therapies and the increased use of high-dose therapy have translated into better outcome for patients with myeloma. We examined the outcome of 2 groups of patients seen at a single institution, one from time of diagnosis and the other from the time of relapse, to examine the survival trends over time. Among 387 patients relapsing after stem-cell transplantation, a clear improvement in overall survival from the time of relapse was seen, with those relapsing after 2000 having a median overall survival of 23.9 versus 11.8 months (P < .001) for those who relapsed prior to this date. This improvement was independent of other prognostic factors. Patients treated with one or more of the newer drugs (thalidomide, lenalidomide, bortezomib) had longer survival from relapse (30.9 vs 14.8 months; P < .001). In a larger group of 2981 patients with newly diagnosed myeloma, those diagnosed in the last decade had a 50% improvement in overall survival (44.8 vs 29.9 months; P < .001). In this study, we demonstrate improved outcome of patients with myeloma in recent years, both in the relapsed setting as well as at diagnosis.

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Impact of Diabetes and Hyperglycemia on Survival in Advanced Breast Cancer Patients

Experimental Diabetes Research ◽

10.1155/2012/732027 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 46

Author(s):

Cynthia Villarreal-Garza ◽

Robin Shaw-Dulin ◽

Fernando Lara-Medina ◽

Ludwing Bacon ◽

Daniel Rivera ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Advanced Breast ◽

Diabetic Patients ◽

Breast Cancer Patients ◽

Cancer Specific Survival ◽

Glucose Levels ◽

Risk Of Death ◽

Mean Glucose ◽

The Impact

Purpose. We examined the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer (BC).Methods. We performed a retrospective analysis of 265 patients with advanced BC receiving palliative chemotherapy. BC-specific mortality was compared for diabetic and nondiabetic patients as well as for patients that presented hyperglycemia during treatment.Results. No difference was observed between the diabetic and nondiabetic patients in terms of overall survival (OS). A difference in OS was observed between nondiabetic patients and diabetic patients who had hyperglycemia. The OS was greater in diabetic patients with proper metabolic control than diabetic patients with hyperglycemia. The risk of death was higher in patients with mean glucose levels 130 mg/dL during treatment. Several factors were associated with poor OS: tumor stage, hormone-receptor-negative tumors, HER2 negative disease, multiple metastatic sites, presence of visceral metastases, and mean glucose 130 mg/dL.Conclusion. Elevated glucose levels are associated with a poor outcome in diabetic and nondiabetic patients in contrast to patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians should monitor glucose levels during treatment for advanced breast cancer disease and take action to maintain normal glucose levels.

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Prognostic analysis of very early onset pancreatic cancer: a population-based analysis

PeerJ ◽

10.7717/peerj.8412 ◽

2020 ◽

Vol 8 ◽

pp. e8412

Author(s):

Dongjun Dai ◽

Yanmei Wang ◽

Xinyang Hu ◽

Hongchuan Jin ◽

Xian Wang

Keyword(s):

Pancreatic Cancer ◽

Early Onset ◽

Older Patients ◽

Proportional Hazards ◽

Risk Model ◽

Competing Risk ◽

Cancer Specific Survival ◽

Subdistribution Hazard ◽

Risk Of Death ◽

The Impact

Background We aimed to use competing risk model to assess whether very early onset pancreatic cancer (VEOPC ) (<45 years) had a worse prognosis than older pancreatic cancer (PC) patients, and to build a competing risk nomogram for predicting the risk of death of VEOPC. Methods We selected pancreatic adenocarcinoma (PDAC) patients as our cohort from the Surveillance, Epidemiology, and End Results (SEER) database. The impact of cancer specific death was estimated by competing risk analysis. Multivariate Fine-Gray regression for proportional hazards modeling of the subdistribution hazard (SH) model based nomogram was constructed, which was internally validated by discrimination and calibration with 1,000 bootstraps. Results Our cohort included 1,386 VEOPC patients and 53,940 older patients. We observed that in unresectablePDAC patients, VEOPC had better cancer specific survival (CSS) than each older group (45–59 years, 60–69 years, 70–79 years and >79 years). There was no significant prognostic difference between VEOPC and each older group in resectablePDAC. Our competing nomogram showed well discrimination and calibration by internal validation. Conclusion For unresectable PDAC patients, VEOPC had better CSS than older patients. Our competing risk nomogram might be an easy-to-use tool for the specific death prediction of VEOPC patients with PDAC.

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