Value of Radiotherapy in Primary Gastric Cancer and Establishment of a Prognostic Nomogram Model

Abstract Background: This study aimed to compare the use of radiotherapy (RT) in gastric cancer (GC) patients from the SEER database and established a nomogram to assess cancer-specific survival (CSS).Methods: Patients from the SEER database between 2004 and 2013 were analyzed. Survival was analyzed by Kaplan-Meier curves and log-rank test. Prognostic factors in multivariate Cox analysis were screened to construct a nomogram. The performance the nomogram was validated via concordance index (C-index), calibration plots, and decision curve analyses (DCAs). Results: 9653 GC patients were analyzed totally. In the entire cohort, patients who received pre/postoperative RT had better survival than those who did not receive RT (P = 0.043 and < 0.001, respectively). Similar results were observed in lymph node-positive patients. However, no significant survival benefit was seen in lymph node-negative patients between postoperative RT group and no RT group (P = 0.057), but patients who received postoperative RT and those who did not receive RT experienced better survival than those who received preoperative RT (P < 0.001 and 0.001, respectively). Prognostic factors of GC analyzed by Cox regression model included age, race, tumor grade, tumor histology type, primary tumor site, T stage, lymph node metastasis ratio, RT status, and chemotherapy information independently (P < 0.001). The nomogram was established and showed excellent prediction performance, and its C-index of 0.725 were significantly higher than those of nomograms based AJCC system with C-index at 0.643. In addition, the calibration plots performed good consistency between the predicted and actual survival probabilities, and the DCAs indicated better clinical net benefits than the traditional AJCC system.Conclusions: RT can improve CSS in GC patients, especially those with positive lymph nodes. The construction and verification of a nomogram based on SEER database can effectively predict the survival outcomes of GC patients.

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Distinguish the Role of Radiotherapy From Chemoradiotherapy for Gastric Cancer With Behavior of Metastasis-Indolent in Lymph Node

Technology in Cancer Research & Treatment ◽

10.1177/1533033820959400 ◽

2020 ◽

Vol 19 ◽

pp. 153303382095940

Author(s):

Yunfei Zhi ◽

Zhousheng Lin ◽

Jinyuan Ma ◽

Weiming Mou ◽

Xinhua Chen

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Adjuvant Treatment ◽

Cox Regression ◽

Seer Database ◽

Cancer Specific Survival ◽

Nccn Guidelines ◽

Tumor Invasiveness ◽

Cancer Network

Background: Although the landmark INT-0116 trial and National Comprehensive Cancer Network (NCCN) guidelines recommended pT3-4Nx gastric cancer (GC) patients to receive chemoradiotherapy, the role of radiotherapy has not been distinguished from chemoradiotherapy. Methods: GC with behavior of metastasis-indolent in lymph node (MILN) being confirmed with more than 15 examined LNs after gastrectomy were identified using the Surveillance, Epidemiology and End Result (SEER) database. The cancer-specific survival (CSS) of subgroups for radiotherapy, chemotherapy, chemoradiotherapy and non-adjuvant-treatment were compared. Propensity score matching (PSM) was performed between radiotherapy and non-radiotherapy subgroups to further distinguish the role of radiotherapy from chemoradiotherapy. Cox regression was performed to identify whether radiotherapy or chemotherapy could independently improve prognosis. Results: We identified 690 MILN GC patients in SEER database. 5-year CSS was 71.9% in radiotherapy subgroup and 75.1% in non-radiotherapy subgroup(HR = 1.013, 95% CI = 0.714-1.438, p = 0.940), 75.6% in chemotherapy subgroup and 68.5% in non-chemotherapy subgroup(HR = 0.616, 95% CI = 0.430-0.884, p = 0.008), 52.5% in radiotherapy-alone subgroup and 71.9% in non-adjuvant treatment group (HR = 1.604, 95% CI = 0.575-4.471, p = 0.360), 72.9% in chemoradiotherapy subgroup and 79.5% in chemotherapy-alone subgroup (HR = 1.365, 95% CI = 0.859-2.172, p = 0.185), respectively. Further, PSM markedly improved balance of variables between radiotherapy subgroup and non-radiotherapy subgroup. After PSM, the role of the variables of radiotherapy and chemotherapy in contributing to improving CSS are consistent with that before PSM. Cox regression showed chemotherapy, tumor size, tumor invasiveness and Lauren classification were independent prognostic factors, but not including radiotherapy. Conclusions: Chemoradiotherapy confers superior prognosis to MILN GC patients compared with surgery alone might only be attributed to chemotherapy rather than radiotherapy.

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Proportion and Prognosis of Bone Metastases from Gastric Cancer in SEER database

10.21203/rs.2.11460/v1 ◽

2019 ◽

Author(s):

zepang sun ◽

Hao Chen ◽

Zhen Han ◽

Jiang Yu ◽

Weicai Huang ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Bone Metastases ◽

Cox Regression ◽

Cox Model ◽

Population Based ◽

Rank Test ◽

Seer Database ◽

Entire Cohort ◽

Kaplan Meier

Abstract Purpose The purpose of this study was to analyze the proportion and prognosis of bone metastases at diagnosis of gastric cancer using population-based data from SEER. Patients and methods Patients with gastric cancer and bone metastases (GCBM) at the time of diagnosis in advanced gastric cancer were identified using the Surveillance, Epidemiology and End Result (SEER) database of the National Cancer Institute. Multivariable logistic and Cox regression were performed to identify predictors of the presence of GCBM at diagnosis and factors associated with all-cause mortality and gastric cancer-specific mortality. Survival curves were obtained according to the Kaplan-Meier method and compared using the log-rank test. Results We identified 975 patients with gastric cancer and bone metastases at the time of diagnosis, representing 5.31% of the entire cohort and 13.35% of the subset with metastatic disease to any distant site. Among entire cohort, multivariable logistic regression identified five factors (lower age, diffused-type, adverse pathology grade, N1 staging and presence of more extraosseous metastases to liver, lung and brain.) as positive predictors of the presence of bone metastases at diagnosis. Median survival among the entire cohort with GCBM was 4.0 months (interquartile range: 1.0-8.0mo). Multivariable Cox model in SEER cohort confirmed two factors (non-cardia stomach and absence of chemotherapy) as negative predictors for overall survival. We also found poor survival in non-surgical patients using Fine and Gray’s competing risk regression model. Conclusion The findings of this study provided population-based estimates of the proportion and prognosis for GCBM at time of diagnosis. These findings provided guidance for screening and treatment of GCBM patients. Chemotherapy may make benefit for overall survival, but the role of surgery remained to be determined by further research.

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A practical nomogram from the SEER database to predict the prognosis of hepatocellular carcinoma patients with lymph node metastasis

10.21203/rs.3.rs-29257/v1 ◽

2020 ◽

Author(s):

Kai Zhang ◽

Changcheng Tao ◽

Jianxiong Wu ◽

Weiqi Rong

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cox Regression ◽

Rank Test ◽

Seer Database ◽

Survival Curves ◽

Node Metastasis ◽

Log Rank Test

Abstract Background: The presence of lymph node metastases is related to poor survival outcomes in hepatocellular carcinoma patients and because of the reported low probability of lymph node metastasis, research into the prognoses of such patients is difficult to conduct. In this study, we aimed to develop a nomogram model to predict the prognosis of HCC patients with lymph node metastasis and provided a reasonable basis for the choice of follow-up treatment.Methods: HCC patients diagnosed with LN metastasis from 2010 to 2015 were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate Cox regression and lasso regression were used to screen prognostic factors. Cox multiple-factor analysis was employed to investigate the independent prognostic factors for survival. The concordance index (C-index) and calibration curve were used to evaluate the predictive performance of our model. The clinical benefit was assessed via decision curve analysis (DCA). The survival was analyzed using Kaplan-Meier method and the differences among survival curves were compared by the log-rank test.Results: Patients were randomized into the training group (944 patients) and the validation group (402 patients) in a 70:30 ratio. Grade, T stage, surgery to the liver, chemotherapy, radiation recode, AFP, fibrosis score, tumor size group, M stage were selected as independent prognostic factors, and we developed nomograms using these variables. The c-indices of the training and validation groups were 0.70 and 0.73, respectively. The calibration curves for probability of survival showed good agreement. The DCA indicated that the nomogram had positive net benefits. Patients were divided into two risk groups according to our model, survival curves were drawn, and the log-rank test was performed, the p-value of which was <0.001.Conclusions: The nomogram can accurately predict the prognosis of HCC patients with lymph nodes metastasis and provide a reasonable basis for treatment.

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Clinicopathological characteristics and prognostic factors of cervical adenocarcinoma

Scientific Reports ◽

10.1038/s41598-021-86786-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Wang ◽

Bo Yuan ◽

Zhen-huan Zhou ◽

Wei-wei Han

Keyword(s):

Prognostic Factors ◽

Tumor Size ◽

Survival Rates ◽

Tumor Grade ◽

Figo Stage ◽

Cervical Adenocarcinoma ◽

Stage Ii ◽

Prognostic Indicators ◽

Rank Test ◽

Cancer Specific Survival

AbstractWe aimed to assess the clinicopathological features and to determine the prognostic factors of cervical adenocarcinoma (AC). Relevant data were extracted from surveillance, epidemiology and end results database from 2004 to 2015. The log-rank test and Cox proportional hazard analysis were subsequently utilized to identify independent prognostic factors. A total of 3102 patients were identified. The enrolled patients were characterized by higher proportion of early FIGO stage (stage I: 65.9%; stage II: 14.1%), low pathological grade (grade I/II: 49.1%) and tumor size ≤ 4 cm (46.8%). The 5- and 10-year cancer-specific survival rates of these patients were 74.47% and 70.00%, respectively. Meanwhile, the 5- and 10-year overall survival (OS) rates were 71.52% and 65.17%, respectively. Multivariate analysis revealed that married status, surgery as well as chemotherapy were independent favorable prognostic indicators. Additionally, aged > 45, tumor grade III/IV, tumor size > 4 cm, advanced FIGO stage and pelvic lymph node metastasis (LNM) were unfavorable prognostic factors (all P < 0.01). Stratified analysis found that patients without surgery could significantly benefit from chemotherapy and radiotherapy. In addition, chemotherapy could significantly improve the survival in stage II–IV patients and radiotherapy could only improve the survival in stage III patients (all P < 0.01). Marital status, age, grade, tumor size, FIGO stage, surgery, pelvic LNM and chemotherapy were significantly associated with the prognosis of cervical AC.

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

10.21203/rs.3.rs-403708/v1 ◽

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.

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Adenosquamous Carcinoma of the Cervix: A Population-Based Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.652850 ◽

2021 ◽

Vol 11 ◽

Author(s):

Pengfei Cui ◽

Xiaofeng Cong ◽

Chen Chen ◽

Lei Yang ◽

Ziling Liu

Keyword(s):

Prognostic Factors ◽

Calibration Curve ◽

Cox Regression ◽

Adenosquamous Carcinoma ◽

Staging System ◽

Predictive Performance ◽

Tumor Grade ◽

Population Based ◽

Cancer Specific Survival ◽

Discrimination Ability

BackgroundDue to the rarity of adenosquamous carcinoma of the cervix (ASCC), studies on the incidence, prognostic factors, and treatment outcomes of ASCC remain scarce. Therefore, we performed a retrospective population-based study to systematically investigate the characteristics of ASCC patients.MethodsPatients with a histopathologically confirmed diagnosis of ASCC were enrolled from the Surveillance, Epidemiology, and End Results database between 1975 and 2016. Univariate and multivariate Cox regression analyses were performed to identify the potential predictors of cancer-specific survival (CSS) in patients with ASCC. Selected variables were integrated to establish a predictive nomogram and the predictive performance of the nomogram was estimated using Harrell’s concordance index (C-index), calibration curve, and decision curve analysis (DCA).ResultsA total of 1142 ASCC patients were identified and included in this study and were further randomized into the training and validation cohorts in a 7:3 ratio. The age-adjusted incidence of ASCC declined from 0.19 to 0.09 cases per 100,000 person-years between 2000 and 2017, with an annual percentage change of -4.05% (P<0.05). We identified age, tumor grade, FIGO stage, tumor size, and surgical procedure as independent predictors for CSS in ASCC patients and constructed a nomogram to predict the 3- and 5-year CSS using these prognostic factors. The calibration curve indicated an outstanding consistency between the nomogram prediction and actual observation in both the training and testing cohorts. The C-index was 0.7916 (95% CI: 0.7990-0.8042) and 0.8148 (95% CI: 0.7954-0.8342) for the training and testing cohorts, respectively, indicating an excellent discrimination ability of the nomogram. The DCA showed that the nomogram exhibited more clinical benefits than the FIGO staging system.ConclusionsWe established and validated an accurate predictive nomogram for ASCC patients based on several clinical characteristics. This model might serve as a useful tool for clinicians to estimate the prognosis of ASCC patients.

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Survival outcomes based on race in gastric carcinoma: A SEER database analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.5 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 5-5

Author(s):

N. Didwaniya ◽

R. J. Edmonds ◽

P. T. Silberstein ◽

S. Subbiah

Keyword(s):

Gastric Cancer ◽

Gastric Carcinoma ◽

Survival Rates ◽

Tumor Grade ◽

The United States ◽

Lymph Node Involvement ◽

Tnm Staging ◽

Treatment Modalities ◽

Seer Database ◽

Cancer Specific Survival

5 Background: Gastric cancer is one of the leading causes of cancer related deaths worldwide with the incidence declining in the United States. However the prognosis remains poor with variable survivals being reported among different races. We analyzed the effect of race on patterns of disease presentation and survival rates using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: A total of 9,851 patients were diagnosed with gastric cancer from year 2004 to 2007 were identified from SEER database. Age, race, TNM staging, grade, treatment modalities utilized and cancer specific survival was collected. Results: Out of 9,851 patients, 64.63% were white, 12.17% were black, and 13.04% were Asian-Pacific islanders. Median age was 73 years for whites, 70 years in blacks, and 71 years in Asians. Sex distribution amongst races was more or less similar with 58.83% of whites, 59.47% of blacks, and 54.24% of Asians being men. 23.62% of whites had T1 lesions, 28.10% had T2, 19.58% were T3 and 28.70% had T4 lesions. 26.76% of blacks presented with T1 lesions, 26.63% with T2, 16.08% with T3 and 30.53% with T4. 18.69% of Asians had T1 lesions, 26.84% with T2, 23.44% had T3 and 31.03% had T4 lesions. 37.80% of whites, 36.70% of blacks, and 44.44% of Asians had lymph node involvement. Tumor grade was similar among all races. Surgery was performed in 31.49% of whites, 33.13% of blacks, and 40.48% of Asians. 14.68% of whites, 14.10% of blacks, and 19.43 % of all Asians underwent radiation therapy. Median overall survival in localized disease was 44 months, 43 months and 98 months (p < 0.0001) while in regional disease it was 16 months, 15 months and 23 months in whites, blacks and Asians respectively (p < 0.0001). Median survival in distant disease was 4 months in both whites and blacks; it was 5 months in Asians (p < 0.0001). Conclusions: Cancer-specific survival in gastric carcinoma is significantly better in localized, regional and metastatic disease in Asians when compared to whites and blacks independent of T stage, grade, nodal involvement and treatment modalities utilized. The reason for this observation is unclear, exposure and genetic factors are potential causes and this needs to be investigated. No significant financial relationships to disclose.

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Comparison of survival in non-metastatic inflammatory and other T4 breast cancers: a SEER population-based analysis

BMC Cancer ◽

10.1186/s12885-021-07855-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dechuang Jiao ◽

Jingyang Zhang ◽

Jiujun Zhu ◽

Xuhui Guo ◽

Yue Yang ◽

...

Keyword(s):

Breast Cancer ◽

Cox Model ◽

Survival Rates ◽

Tumor Grade ◽

Population Based ◽

Rank Test ◽

Breast Cancers ◽

Significant Independent Predictor ◽

Cancer Specific Survival ◽

7Th Edition

Abstract Background Previous studies have reported poor survival rates in inflammatory breast cancer (IBC) patients than non-inflammatory local advanced breast cancer (non-IBC) patients. However, until now, the survival rate of IBC and other T4 non-IBC (T4-non-IBC) patients remains unexplored. Methods Surveillance, Epidemiology, and End Results (SEER) database was searched to identify cases with confirmed non-metastatic IBC and T4-non-IBC who had received surgery, chemotherapy, and radiotherapy between 2010 and 2015. IBC was defined as per the American Joint Committee on Cancer (AJCC) 7th edition. Breast Cancer-Specific Survival (BCSS) was estimated by plotting the Kaplan-Meier curve and compared across groups by using the log-rank test. Cox model was constructed to determine the association between IBC and BCSS after adjusting for age, race, stage of disease, tumor grade and surgery type. Results Out of a total of 1986 patients, 37.1% had IBC and mean age was 56.6 ± 12.4. After a median follow-up time of 28 months, 3-year BCSS rate for IBC and T4-non-IBC patients was 81.4 and 81.9%, respectively (log-rank p = 0.398). The 3-year BCSS rate in HR−/HER2+ cohort was higher for IBC patients than T4-non-IBC patients (89.5% vs. 80.8%; log-rank p = 0.028), and in HR−/HER2- cohort it was significantly lower for IBC patients than T4-non-IBC patients (57.4% vs. 67.5%; log-rank p = 0.010). However, it was identical between IBC and T4-non-IBC patients in both HR+/HER2- (85.0% vs. 85.3%; log-rank p = 0.567) and HR+/HER2+ (93.6% vs. 91.0%, log-rank p = 0.510) cohorts. After adjusting for potential confounding variables, we observed that IBC is a significant independent predictor for survival of HR−/HER2+ cohort (hazards ratio [HR] = 0.442; 95% CI: 0.216–0.902; P = 0.025) and HR−/HER2- cohort (HR = 1.738; 95% CI: 1.192–2.534; P = 0.004). Conclusions Patients with IBC and T4-non-IBC had a similar BCSS in the era of modern systemic treatment. In IBC patients, the HR−/HER2+ subtype is associated with a better outcome, and HR−/HER2- subtype is associated with poorer outcomes as compared to the T4-non-IBC patients.

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The Effect of Marital Status on Survival of Patients with Gastrointestinal Stromal Tumors: A SEER Database Analysis

Gastroenterology Research and Practice ◽

10.1155/2018/5740823 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Wei Song ◽

Chuan Tian

Keyword(s):

Prognostic Factor ◽

Marital Status ◽

Gastrointestinal Stromal Tumors ◽

Cox Regression ◽

Seer Database ◽

Cancer Specific Survival ◽

Stromal Tumors ◽

Kaplan Meier ◽

Risk Of Cancer ◽

The Impact

Background. Marital status has been reported to be a prognostic factor in multiple malignancies. However, its prognostic value on gastrointestinal stromal tumors (GISTs) have not yet been determined. The objective of the present analysis was to assess the effects of marital status on survival in patients with GISTs. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze 6195 patients who were diagnosed with GISTs from 2001 to 2014. We also use Kaplan-Meier analysis and Cox regression to analyze the impact of marital status on cancer-specific survival (CSS). Results. Patients in the married group had more frequency in white people, more high/moderate grade tumors, and were more likely to receive surgery. Widowed patients had a higher proportion of women, a greater proportion of older patients (>60 years), and more common site of the stomach. Multivariate analysis demonstrated that marital status was an independent prognostic factor for GISTs (P<0.001). Married patients had better CSS than unmarried patients (P<0.001). Subgroup analysis suggested that widowed patients had the lowest CSS compared with all other patients. Conclusions. Marital status is a prognostic factor for survival in patients with GISTs, and widowed patients are at greater risk of cancer-specific mortality.

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