Bayesian variable selection and survival modeling: Assessing the most important comorbidities that impact lung and colorectal cancer survival in Spain

Abstract Cancer survival represents one of the main indicators of interest in cancer epidemiology. However, the survival of cancer patients can be affected by a number of factors, such as comorbidities, that may interact with the cancer tumour. Moreover, it is of interest to understand how different cancer sites and tumour stages are affected by different comorbidities. Identifying the comorbidities that affect cancer survival is thus of interest as it can be used to identify factors driving the survival of cancer patients. This information can also be used to identify vulnerable groups of patients with comorbidities that may lead to a worst prognosis of cancer. We address these questions and propose a principled selection and evaluation of the effect of comorbidities in the overall survival in cancer patients. In the first step, we apply a Bayesian variable selection method that can be used to identify the comorbidities that predict overall survival. In the second step, we build a general Bayesian survival model that accounts for time-varying effects. In the third step, we derive several posterior predictive measures to quantify the effect of individual comorbidities on the population overall survival. We present applications to data on lung and colorectal cancers from two Spanish population-based cancer registries. The proposed methodology is implemented with a combination of the R-packages mombf and rstan. We provide the code for reproducibility at https://github.com/migariane/BayesVarImpComorbiCancer.

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Studying Survival of Cancer Patients in Different Populations: Its Potential and Role

Tumori Journal ◽

10.1177/030089169708300104 ◽

1997 ◽

Vol 83 (1) ◽

pp. 3-8 ◽

Cited By ~ 15

Author(s):

Andrea Micheli ◽

Gemma Gatta ◽

Arduino Verdecchia

Keyword(s):

Cancer Patients ◽

Health Expenditure ◽

Cancer Survival ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Malignant Neoplasms ◽

Regional Health ◽

Italian Regions ◽

Different Populations

Rationale Survival figures from a population-based study incorporate the overall practice in diagnosis, cure and clinical follow-up for a specific disease within a given health care system. Being the outcome of a number of individual, social and economical aspects, population-based survival may be thought as index for measuring the level of a country's development. Data The EUROCARE project, a European Cancer Registries (CR) concerted action, provided reliable information on survival for more than 800,000 cancer patients from 11 European countries. A great deal of epidemiologic information has derived from EUROCARE. Women had a longer survival than men for all studied tumour sites, except for the colon. European survival variability was fairly high for several cancers, but it was lower for cancers with a relatively good prognosis and those sensitive to treatment. The ranking of populations of cancer survival tended to be fairly stable for many cancers: CR of Switzerland and Finland ranked high and Polish CR low. Denmark, Italian and France CR did not substantially differ from the European survival average. For most cancers, prognosis improved during the studied period (years of diagnosis: 1978–1985). Survival figures for colon (r = 0.74, males; r = 0.73, women) and female breast cancer (r = 0.57) well correlated with the national health expenditure of different participating countries. The ITACARE study, a new Italian Cancer Registries collaborative project involving more than 100,000 cancer patients, was set up to study survival differences within the country. Survival of cancer patients was not homogeneous in 7 studied Italian regions (the estimated 5-year relative survival for all malignant neoplasms combined ranked from 37.8% in CR of Sicily to 42.1% in those of Emilia-Romagna). The lowest levels of regional health expenditures were accompanied by the lowest levels of prognosis for overall cancers. However, a relatively low correlation among patient cancer survival and the regional health expenditure (r = 0.21) was found, suggesting that other factors such as different efficiency in managing cancer may play a role in explaining the intracountry differences. Conclusions Population-based survival figures may be used to study epidemiologic aspects, comparing different health systems, and may be interpreted as indexes for discussing inequalities in health in different populations.

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Real-world Treatment Patterns and Overall Survival in Locally Advanced and Metastatic Urothelial Tract Cancer Patients Treated with Chemotherapy in Denmark in the Preimmunotherapy Era: A Nationwide, Population-based Study

European Urology Open Science ◽

10.1016/j.euros.2020.12.002 ◽

2021 ◽

Vol 24 ◽

pp. 1-8

Author(s):

Lise H. Omland ◽

Henriette Lindberg ◽

Andreas Carus ◽

Anne Birgitte Als ◽

Niels Viggo Jensen ◽

...

Keyword(s):

Overall Survival ◽

Cancer Patients ◽

Real World ◽

Locally Advanced ◽

Population Based ◽

Treatment Patterns ◽

Population Based Study ◽

Tract Cancer

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Variations in the Survival of Adult Cancer Patients in Italy

Tumori Journal ◽

10.1177/030089169708300112 ◽

1997 ◽

Vol 83 (1) ◽

pp. 497-504 ◽

Cited By ~ 24

Author(s):

Gemma Gatta ◽

Eva Buiatti ◽

Ettore Conti ◽

Vincenzo De Lisi ◽

Fabio Falcini ◽

...

Keyword(s):

Cancer Patients ◽

Geographical Area ◽

Central Italy ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Italian Population ◽

Age Class ◽

General Survival ◽

General Improvement

Aims As part of the ITACARE project, the present study analyzed and compared population-based data on the survival of adult cancer patients in Italy, according to sex, age, period of diagnosis and geographical area. Methods Nine Italian population-based cancer registries provided data on all their cancer patients (total 90,431 cases) followed for at least 5 years and diagnosed during the period 1978–1989. About 10% of the Italian population is covered by these registries. The data was analyzed by means of a multivariate model. Results The major findings were that there was a general improvement in 5-year relative survival over the study period (from 33% to 39%) and that there were significant differences in survival between different areas of the country, particularly for cancer sites which respond well to treatment. In general, the area covered by the Ragusa (Sicily) registry was characterized by significantly worse survival than other registry populations. Other important findings were that for all malignant cancer sites 5-year relative survival decreased with age from 50% for the youngest age class (15–44 years) to 27% for the oldest age class (75+ years) and that women have a better prognosis for most cancer sites (overall 5-year relative survival in women 48% vs 32% in men). Conclusions The significant regional differences in survival may reflect unequal provision of care, particularly between northern-central Italy and the south. The reasons for the general survival improvement with time are not completely understood, whereas the marked overall sex difference is related to the fact that the commonest cancer in women (breast cancer) is eminently more treatable than the commonest malignancy in men (lung cancer). The unfavorable trend with increasing age may be due to increasing difficulty in applying complete therapy protocols as general health declines, sometimes in relation to an advanced cancer stage at diagnosis.

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Breast Subtypes and Prognosis of Breast Cancer Patients With Initial Bone Metastasis: A Population-Based Study

Frontiers in Oncology ◽

10.3389/fonc.2020.580112 ◽

2020 ◽

Vol 10 ◽

Author(s):

Deyue Liu ◽

Jiayi Wu ◽

Caijin Lin ◽

Lisa Andriani ◽

Shuning Ding ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Metastatic Breast Cancer ◽

Bone Metastasis ◽

Cancer Patients ◽

Metastatic Breast ◽

Risk Groups ◽

Population Based ◽

Breast Cancer Patients

BackgroundMetastatic breast cancer (MBC) is a highly heterogeneous disease and bone is one of the most common metastatic sites. This retrospective study was conducted to investigate the clinical features, prognostic factors and benefits of surgery of breast cancer patients with initial bone metastases.MethodsFrom 2010 to 2015, 6,860 breast cancer patients diagnosed with initial bone metastasis were analyzed from Surveillance, Epidemiology, and End Results (SEER) database. Univariate and Multivariable analysis were used to identify prognostic factors. A nomogram was performed based on the factors selected from cox regression result. Survival curves were plotted according to different subtypes, metastatic burdens and risk groups differentiated by nomogram.ResultsHormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) positive patients showed the best outcome compared to other subtypes. Patients of younger age (<60 years old), white race, lower grade, lower T stage (<=T2), not combining visceral metastasis tended to have better outcome. About 37% (2,249) patients received surgery of primary tumor. Patients of all subtypes could benefit from surgery. Patients of bone-only metastases (BOM), bone and liver metastases, bone and lung metastases also showed superior survival time if surgery was performed. However, patients of bone and brain metastasis could not benefit from surgery (p = 0.05). The C-index of nomogram was 0.66. Cutoff values of nomogram point were identified as 87 and 157 points, which divided all patients into low-, intermediate- and high-risk groups. Patients of all groups showed better overall survival when receiving surgery.ConclusionOur study has provided population-based prognostic analysis in patients with initial bone metastatic breast cancer and constructed a predicting nomogram with good accuracy. The finding of potential benefit of surgery to overall survival will cast some lights on the treatment tactics of this group of patients.

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Nomograms for predicting specific distant metastatic sites and overall survival of colorectal cancer patients: A large population‐based real‐world study

Clinical and Translational Medicine ◽

10.1002/ctm2.20 ◽

2020 ◽

Vol 10 (1) ◽

pp. 169-181

Author(s):

Shaobo Mo ◽

Xin Cai ◽

Zheng Zhou ◽

Yaqi Li ◽

Xiang Hu ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Cancer Patients ◽

Real World ◽

Large Population ◽

Population Based ◽

Metastatic Sites ◽

Colorectal Cancer Patients

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Cancer cure for 32 cancer types: results from the EUROCARE-5 study

International Journal of Epidemiology ◽

10.1093/ije/dyaa128 ◽

2020 ◽

Vol 49 (5) ◽

pp. 1517-1525

Author(s):

Luigino Dal Maso ◽

Chiara Panato ◽

Andrea Tavilla ◽

Stefano Guzzinati ◽

Diego Serraino ◽

...

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Lung Cancers ◽

Pancreatic Cancers ◽

Corpus Uteri ◽

Cure Fraction ◽

Prostate Cancers

Abstract Background Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. Methods 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15–74 years in 1990–2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. Results LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65–74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. Conclusions Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients’ quality of life.

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