scholarly journals Endoscopic and Surgical Treatment of T1N0M0 Colorectal Neuroendocrine Tumors: A Population-Based Comparative Study

2020 ◽  
Author(s):  
Hanlong Zhu ◽  
Si Zhao ◽  
Kun Ji ◽  
Wei Wu ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Population Based Study

Abstract Background: With the rapid advances in endoscopic technology, endoscopic therapy (ET) is increasingly applied to the treatment of small (≤20 mm) colorectal neuroendocrine tumors (NETs). However, long-term data comparing ET and surgery for management of T1N0M0 colorectal NETs are lacking. The purpose of this work was to compare overall survival (OS) and cancer-specific survival (CSS) of such patients with ET or surgery.Methods: Patients with T1N0M0 colorectal NETs were identified within the Surveillance Epidemiology and End Results (SEER) database (2004-2016). Demographics, tumor characteristics, therapeutic methods, and survival were compared. Propensity score matching (PSM) was used 1:3 and among this cohort, Cox proportional hazards regression models were performed to evaluate correlation between treatment and outcomes.Results: Of 4487 patients with T1N0M0 colorectal NETs, 1125 were identified in the matched cohort, among whom 819 (72.8%) underwent ET and 306 (27.2%) underwent surgery. There was no difference in the 5-year and 10-year OS and CSS rates between the 2 treatment modalities. Likewise, analyses stratified by tumor size and site showed that patients did not benefit more from surgery compared with ET. Moreover, multivariate analyses found no significant differences in OS [Hazard Ratio (HR) = 0.857, 95% Confidence Interval (CI): 0.513–1.431, P = 0.555] and CSS (HR = 0.925, 95% CI: 0.282–3.040, P = 0.898) between the 2 groups. Similar results were observed when comparisons were limited to patients with different tumor size and site.Conclusions: In this population-based study, patients treated endoscopically had comparable long-term survival compared with those treated surgically, which demonstrates ET as an alternative to surgery in T1N0M0 colorectal NETs.

scholarly journals Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion

2020 ◽  
Author(s):  
Heng Zou ◽  
Wenhao Chen ◽  
Huan Wang ◽  
Li Xiong ◽  
Yu Wen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Grading System ◽  
Term Survival ◽  
Proportional Hazards Regression ◽  
Disease Outcomes ◽  
Single Tumor

Abstract Overview and objective: Although evidence for the application of albumin–bilirubin (ALBI) grading system to assess liver function in hepatocellular carcinoma (HCC) is available, less is known whether it can be applied to determine the prognosis of single HCC with different tumor sizes. This study aimed to address this gap.Methods: Here, we enrolled patients who underwent hepatectomy due to single HCC from the year 2010 to 2014. Analyses were performed to test the potential of ALBI grading system to monitor the long-term survival of single HCC subjects with varying tumor sizes.Results: Overall, 265 participants were recruited. The overall survival (OS) among patients whose tumors were ≤ 7 cm was remarkably higher compared to those whose tumors were > 7 cm. The Cox proportional hazards regression model identified the tumor differentiation grade, ALBI grade, and maximum tumor size as key determinants of the OS. The ALBI grade could stratify the patients who had a single tumor ≤ 7 cm into two distinct groups with different prognoses. The OS between ALBI grades 1 and 2 was comparable for patients who had a single tumor > 7 cm.Conclusions: We show that ALBI grading system can predict disease outcomes of single HCC patients with tumor size ≤ 7 cm. However, the ALBI grade may not predict capability the prognosis of patients with single tumor > 7 cm.

scholarly journals Breast Angiosarcoma: a SEER Population- Based Study

2021 ◽  
Author(s):  
Zhengshui Xu ◽  
Xiaopeng Li ◽  
Jing Guo ◽  
Liyue Yuan ◽  
Zilu Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Population Based ◽  
Therapeutic Strategies ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Matched Data ◽  
The Impact ◽  
Extent Of Disease

Abstract Background Breast angiosarcoma is a rare malignancy with poor survival. Due to the paucity of data, the generation of high-quality evidence for its high-risk features and the impact of treatment modalities on survival have been hampered. Objective To examine high-risk features and the impact of treatment modalities on disease-specific survival (DSS) in breast angiosarcoma and differences between breast angiosarcoma cases with and without other prior cancers. Methods In this retrospective study, patients with breast angiosarcoma diagnosed from 1975 to 2016 were identified from the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression analysis adjusted for age, race, decade at diagnosis, location, pathologic grade, extent of disease, tumor size, and therapy to model DSS outcomes. Propensity score matching analyses were performed to adjust for the differences between breast angiosarcoma cases with and without other prior cancers to compare their DSS values. A Kaplan-Meier curve was used to visualize the cumulative survival probability. Results Of 648 patients with breast angiosarcoma, 55.4% had a prior cancer diagnosis. Older (age ≥ 70) patients were more likely to have breast angiosarcoma with prior cancer than younger patients (64.3% versus 21.8%). Via multivariate analysis, pathologic grade and extent of disease were identified to be significantly associated with DSS in breast angiosarcoma. In matched data, breast angiosarcoma patients with prior cancer had a better DSS than those without prior cancer (HR = 0.60, 95%CI 0.38–0.96, p = 0.0389). In breast angiosarcoma patients without prior cancer, patients with larger tumor size receiving surgery plus radiation or/and chemotherapy might have a better survival than those patients receiving surgery only (HR = 0.38, 95%CI 0.14–0.99, p = 0.0128). DSS is not impacted by the current therapeutic strategies in unselected breast angiosarcoma patients. Conclusions Breast angiosarcoma patients with prior cancer have a better DSS than those without prior cancer. Additionally, some breast angiosarcoma cases with prior cancer may be cutaneous angiosarcomas. Pathologic grade and extent disease are high-risk features. DSS is not impacted by the current therapeutic strategies in unselected breast angiosarcoma patients.

scholarly journals Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion

2020 ◽  
Author(s):  
Wenhao Chen ◽  
Zijian Zhang ◽  
Huan Wang ◽  
Li Xiong ◽  
Yu Wen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Grading System ◽  
Term Survival ◽  
Proportional Hazards Regression ◽  
Disease Outcomes ◽  
Single Tumor

Abstract Background: Although evidence for the application of albumin–bilirubin (ALBI) grading system to assess liver function in hepatocellular carcinoma (HCC) is available, less is known whether it can be applied to determine the prognosis of single HCC with different tumor sizes. This study aimed to address this gap.Methods: Here, we enrolled patients who underwent hepatectomy due to single HCC from the year 2010 to 2014. Analyses were performed to test the potential of ALBI grading system to monitor the long-term survival of single HCC subjects with varying tumor sizes.Results: Overall, 265 participants were recruited. The overall survival (OS) among patients whose tumors were ≤ 7 cm was remarkably higher compared to those whose tumors were > 7 cm. The Cox proportional hazards regression model identified the tumor differentiation grade, ALBI grade, and maximum tumor size as key determinants of the OS. The ALBI grade could stratify the patients who had a single tumor ≤ 7 cm into two distinct groups with different prognoses. The OS between ALBI grades 1 and 2 was comparable for patients who had a single tumor > 7 cm.Conclusions: We show that ALBI grading system can predict disease outcomes of single HCC patients with tumor size ≤ 7 cm. However, the ALBI grade may not predict capability the prognosis of patients with single tumor > 7 cm.

The epidemiologic trends of neuroendocrine tumors in Taiwan: an updated analysis of a nation-wide population-based study

2020 ◽  
Author(s):  
Jeffrey S. Chang ◽  
Li-Tzong Chen ◽  
Yan-Shen Shan ◽  
Pei-Yi Chu ◽  
Chia-Rong Tsai ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Population Based Study ◽  
Pancreatic Net ◽  
The Common ◽  
Near Future ◽  
Wide Population

Abstract Background The incidence of neuroendocrine tumors (NETs) has been increasing in recent decades and there has been a rising awareness by the physicians for the diagnosis of NETs. Several novel agents have been developed and demonstrated to improve the survival of NETs recently. Previously, we reported the incidence and survival of NETs in Taiwan by analyzing the 1996–2008 data from the Taiwan Cancer Registry (TCR). Here we performed an updated analysis on the incidence and survival of NETs in Taiwan from 1996 to 2015. Methods Data for the current analysis were obtained from the TCR and the Death Registry Database. The incidence was age-standardized to the WHO 2000 population and the overall survival was calculated by life-table method. The risk of NETs death was evaluated by performing Cox proportional hazards regression analysis. Results There were a total of 7,760 cases of NETs diagnosed during 1996–2015. The most common site of NETs was rectum (29.65%), followed by lung and bronchus (17.22%), and pancreas (10.71%). The incidence of NETs was 0.244 per 100,000 in 1996 and increased to 3.162 per 100,000 in 2015 with an annual percentage change (APC) of 15.44 (P < 0.0001). The site with the most rapid increase was pancreas with an APC of 28.04 (P < 0.0001). The 5- and 10-year survival rates of all NETs were 54.6% and 45.3%, respectively. Female and younger NETs patients had a better survival. The HR for survival of all NETs diagnosed between 2010 and 2015 was 0.91 (95%CI, 0.84–0.99) compared to those diagnosed between 2004 and 2009. Among the common sites of NETs, an improved survival of NETs diagnosed between 2010 and 2015 compared to those diagnosed between 2004 and 2009 was only observed in pancreatic NET (HR = 0.52, 95% CI, 0.41–0.66). This result was likely due to the early diagnosis and improvement in the treatment of pancreatic NET. Conclusions Overall, the incidence of NETs in Taiwan has continued to increase. The survival of pancreatic NET has shown recent improvement. The development of novel therapeutic agents has the potential to improve the prognosis of NETs of other primary sites in the near future.

scholarly journals Survival Associations between Patient Age and Treatment Modality in Olfactory Neuroblastoma: A Retrospective Population-Based Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2685
Author(s):  
Andre J. Burnham ◽  
Phillip A. Burnham ◽  
Edwin M. Horwitz
Keyword(s):  
Treatment Modality ◽  
Age Groups ◽  
Olfactory Neuroblastoma ◽  
Population Based ◽  
Treatment Modalities ◽  
Long Term Outcomes ◽  
Patient Age ◽  
Population Based Study ◽  
Patient Âgé

Olfactory neuroblastoma (ONB) is a rare neuroepithelial-derived malignancy that usually presents in the nasal cavity. The rarity of ONB has led to conflicting reports regarding associations of patient age and ONB survival and outcome. Moreover, long-term outcomes of chemotherapy and other treatment modalities are speculated. Here, we aimed to compare survival outcomes across age groups through time and determine associations between treatment modality and survival. In this retrospective population-based study, we analyzed the SEER 2000–2016 Database for patients with ONB tumors. Using Kaplan–Meier survival analysis, a significant effect of age and cancer-specific survival (CSS) was observed; geriatric ONB patients had the lowest CSS overall. Generalized linear models and survival analyses demonstrated that CSS of the pediatric patient population was similar to the geriatric group through 100 months but plateaued thereafter and was the highest of all age groups. Radiation and surgery were associated with increased CSS, while chemotherapy was associated with decreased CSS. GLM results showed that tumor grade, stage and lymph node involvement had no CSS associations with age or treatment modality. Our results provide insight for future investigations of long-term outcomes associated with ONB patient age and treatment modality, and we conclude that survival statistics of ONB patients should be analyzed in terms of trends through time rather than fixed in time.

Inter-pregnancy interval and later pediatric cardiovascular health of the offspring – a population-based cohort study

2020 ◽  
pp. 1-5
Author(s):  
Majdi Imterat ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Gali Pariente
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cardiovascular Morbidity ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Inter Pregnancy Interval

Abstract Recent evidence suggests that a long inter-pregnancy interval (IPI: time interval between live birth and estimated time of conception of subsequent pregnancy) poses a risk for adverse short-term perinatal outcome. We aimed to study the effect of short (<6 months) and long (>60 months) IPI on long-term cardiovascular morbidity of the offspring. A population-based cohort study was performed in which all singleton live births in parturients with at least one previous birth were included. Hospitalizations of the offspring up to the age of 18 years involving cardiovascular diseases and according to IPI length were evaluated. Intermediate interval, between 6 and 60 months, was considered the reference. Kaplan–Meier survival curves were used to compare the cumulative morbidity incidence between the groups. Cox proportional hazards model was used to control for confounders. During the study period, 161,793 deliveries met the inclusion criteria. Of them, 14.1% (n = 22,851) occurred in parturient following a short IPI, 78.6% (n = 127,146) following an intermediate IPI, and 7.3% (n = 11,796) following a long IPI. Total hospitalizations of the offspring, involving cardiovascular morbidity, were comparable between the groups. The Kaplan–Meier survival curves demonstrated similar cumulative incidences of cardiovascular morbidity in all groups. In a Cox proportional hazards model, short and long IPI did not appear as independent risk factors for later pediatric cardiovascular morbidity of the offspring (adjusted HR 0.97, 95% CI 0.80–1.18; adjusted HR 1.01, 95% CI 0.83–1.37, for short and long IPI, respectively). In our population, extreme IPIs do not appear to impact long-term cardiovascular hospitalizations of offspring.

scholarly journals Individualized Prediction of Survival Benefits of Pancreatectomy Plus Chemotherapy in Patients With Simultaneous Metastatic Pancreatic Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Duorui Nie ◽  
Guihua Lai ◽  
Guilin An ◽  
Zhuojun Wu ◽  
Shujun Lei ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Survival Curve ◽  
Characteristic Curve ◽  
Cox Proportional Hazards ◽  
Metastatic Pancreatic Cancer ◽  
Calibration Plot ◽  
Term Survival ◽  
Good Ability

BackgroundMetastatic pancreatic cancer (mPC) is a highly lethal malignancy with poorer survival. However, chemotherapy alone was unable to maintain long‐term survival. This study aimed to evaluate the individualized survival benefits of pancreatectomy plus chemotherapy (PCT) for mPC.MethodsA total of 4546 patients with mPC from 2004 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. The survival curve was calculated using the Kaplan-Meier method and differences in survival curves were tested using log-rank tests. Cox proportional hazards regression analyses were performed to evaluate the prognostic value of involved variables. A new nomogram was constructed to predict overall survival based on independent prognosis factors. The performance of the nomogram was measured by concordance index, calibration plot, and area under the receiver operating characteristic curve.ResultsCompared to pancreatectomy or chemotherapy alone, PCT can significantly improve the prognosis of patients with mPC. In addition, patients with well/moderately differentiated tumors, age ≤66 years, tumor size ≤42 mm, or female patients were more likely to benefit from PCT. Multivariate analysis showed that age at diagnosis, sex, marital status, grade, tumor size, and treatment were independent prognostic factors. The established nomogram has a good ability to distinguish and calibrating.ConclusionPCT can prolong survival in some patients with mPC. Our nomogram can individualize predict OS of pancreatectomy combined with chemotherapy in patients with concurrent mPC.

scholarly journals Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

2021 ◽  
Author(s):  
David A. Baran ◽  
Justin Lansinger ◽  
Ashleigh Long ◽  
John M. Herre ◽  
Amin Yehya ◽  
...  
Keyword(s):  
Drug Use ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Heart Transplants ◽  
Term Survival ◽  
Ischemic Time ◽  
Cox Proportional Hazards Models ◽  
Donor Shortage ◽  
United Network

Background: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. Methods: The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. Results: The number and percent of donors with drug use has significantly increased over the study period ( P <0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival ( P <0.0001). Conclusions: Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.

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