A prognostic nomogram in patients with distant metastasis of pancreatic neuroendocrine tumors: a population-based study

2020 ◽  
Vol 16 (2) ◽  
pp. 4369-4379
Author(s):  
Jin-Song Cai ◽  
Hai-Yan Chen ◽  
Yuan-Fei Lu ◽  
Ri-Sheng Yu

Aim: Prognostic factors in patients with distant metastatic pancreatic neuroendocrine tumors (PNETs) remain uncertain. The purpose of our study is to establish a nomogram to predict survival outcomes in patients with metastatic PNETs. Methods: A total of 878 patients diagnosed with PNETs in the Surveillance, Epidemiology and End Results database between 2004 and 2016 were retrospectively identified. The Kaplan–Meier survival analysis with log-rank test was used to analyze survival outcomes. The nomogram was established after a univariate and multivariate Cox analysis. Results: The independent prognostic variables, including age, tumor grade and primary site surgery were applied to develop a nomogram. The original concordance index was 0.773 (95% CI: 0.751–0.795), and the bias-corrected concordance index was 0.769 (95% CI: 0.748–0.791). The internal calibration curves showed well consistency and veracity in predicting cancer-specific survival probabilities. Conclusion: A nomogram was constructed and verified to predict survival outcomes in patients with distant-stage PNETs.

2020 ◽  
Author(s):  
Fangzheng Wang ◽  
Jiang Chuner ◽  
Piao Yongfeng ◽  
Wang Lei ◽  
Yan Fengqin ◽  
...  

Abstract Purpose This study aims to investigate survival outcomes and prognostic factors for upward nasopharyngeal carcinoma (NPC) patients receiving radiation therapy (RT) combined with chemotherapy (CT). Methods A total of 421 previously untreated, newly diagnosed T4N0-1 NPC patients, who were identified within the Surveillance, Epidemiology, and End Results (SEER) registry (years 2004–2015), were collected and retrospectively reviewed. All patients received treatment of RT and CT. Kaplan-Meier analysis was used to evaluate overall survival (OS) and cancer-specific survival (CSS). The differences in OS and CSS were compared using Log-rank test. The independent prognostic factors were established by using univariate and multivariate Cox proportional hazard models. Results With a median follow-up duration of 37 months (range: 3-154 months), the 5-year estimate OS and CSS rates were 59.3% and 63.7%, respectively. N0 and ≥ 65 years were poor prognostic factors for OS and CSS. Moreover, histology and race were associated with OS and CSS. Univariate analysis indicated that ≥ 65 years, N0, NHB and grade III were unfavorable independent prognosticators of OS and CSS. Multivariate analysis demonstrated that ≥ 65 years, N0 and NHB were correlated with poor OS and CSS. Conclusion Patients with stage T4N0-1 NPC receiving RT plus CT had favorable OS and CSS. Moreover, age, N stage and race were independent prognostic factors of OS and CSS.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dechuang Jiao ◽  
Jingyang Zhang ◽  
Jiujun Zhu ◽  
Xuhui Guo ◽  
Yue Yang ◽  
...  

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.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3593-3593
Author(s):  
Jackson Chu ◽  
Ozge Goktepe ◽  
Winson Y. Cheung

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.


2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Xing-kang He ◽  
Wenrui Wu ◽  
Yu-e Ding ◽  
Yue Li ◽  
Lei-min Sun ◽  
...  

Background. In terms of incidence and pathogenesis, right-sided colon cancer (RCC) and left-sided colon cancer (LCC) exhibit several differences. However, whether existing differences could reflect the different survival outcomes remains unclear. Therefore, we aimed to ascertain the role of location in the prognosis. Methods. We identified colon cancer cases from the Surveillance, Epidemiology, and End Results database between 1973 and 2012. Differences among subsites of colon cancer regarding clinical features and metastatic patterns were compared. The Kaplan-Meier curves were conducted to compare overall and disease-specific survival in relation to cancer location. The effect of tumour location on overall and cancer-specific survival was analysed by Cox proportional hazards model. Results. A total of 377,849 patients from SEER database were included in the current study, with 180,889 (47.9%) RCC and 196,960 (52.1%) LCC. LCC was more likely to metastasize to the liver and lung. Kaplan-Meier curves demonstrated that LCC patients had better overall and cancer-specific survival outcomes. Among Cox multivariate analyses, LCC was associated with a slightly reduced risk of overall survival (HR, 0.92; 95% CI, 0.92-0.93) and cancer-specific survival (HR, 0.92; 95% CI, 0.91-0.93), even after adjusted for other variables. However, the relationship between location and prognosis was varied by subgroups defined by age, year at diagnosis, stage, and therapies. Conclusions. We demonstrated that LCC was associated with better prognosis, especially for patients with distant metastasis. Future trails should seek to identify the underlying mechanism.


2019 ◽  
Vol 8 (3) ◽  
pp. 239-251 ◽  
Author(s):  
Chao-bin He ◽  
Yu Zhang ◽  
Zhi-yuan Cai ◽  
Xiao-jun Lin

Aim The role of surgery in the treatment of metastatic pancreatic neuroendocrine tumors (PNETs) was controversial. The objectives of this study were to illustrate the impact of surgery in improving the prognosis of patients with metastatic PNETs and build nomograms to predict overall survival (OS) and cancer-specific survival (CSS) based on a large population-based cohort. Methods Patients diagnosed with metastatic PNETs between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. Nomograms for estimating OS and CSS were established based on Cox regression model and Fine and Grey’s model. The precision of the nomograms was evaluated and compared using concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). Results The study cohort included 1966 patients with metastatic PNETs. It was shown that the surgery provided survival benefit for all groups of patients with metastatic PNETs. In the whole study cohort, 1-, 2- and 3-year OS and CSS were 51.5, 37.1 and 29.4% and 53.0, 38.9 and 31.1%, respectively. The established nomograms were well calibrated, and had good discriminative ability, with C-indexes of 0.773 for OS prediction and 0.774 for CSS prediction. Conclusions Patients with metastatic PNETs could benefit from surgery when the surgery tolerance was acceptable. The established nomograms could stratify patients who were categorized as tumor-node-metastasis (TNM) IV stage into groups with diverse prognoses, showing better discrimination and calibration of the established nomograms, compared with 8th TNM stage system in predicting OS and CSS for patients with metastatic PNETs.


2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 303-303
Author(s):  
Erica S Tsang ◽  
Jennifer L. Spratlin ◽  
Winson Y. Cheung ◽  
Christina Kim ◽  
Shiying Kong ◽  
...  

303 Background: Limited evidence exists for the selection of chemotherapy in APC after first-line (1stL) FFOX. Gemcitabine/nab-paclitaxel (GEMNAB) is publicly funded for second-line (2ndL) use in the provinces of Alberta (AB) and Manitoba (MB), but is not covered in British Columbia (BC). We compared population-based outcomes by region to examine the utility of 2ndL GEMNAB versus GEM alone. Methods: We identified pts treated with 1stL FFOX between 2013-2015 across BC, AB, and MB. Baseline characteristics and treatment regimens were compared between AB/MB and BC. Survival outcomes were assessed by the Kaplan-Meier, and compared with log-rank test. Results: 370 pts treated with 1stL FFOX were identified (145 AB/MB, 225 BC), with a median age of 61y, 42% female, and 68% with metastatic disease (similar in both groups). Receipt of 2ndL therapy was 49% AB/MB vs 44% BC ( p = 0.35), and time from diagnosis to 2ndL therapy measured 7.6 mos AB/MB versus 9.4 mos BC ( p = 0.1). The distribution of 2ndL gemcitabine use was: 72% GEMNAB, 23% GEM in AB/MB versus 27% GEMNAB, 66% GEM in BC ( p < 0.001). Median overall survival (OS) from diagnosis was similar: 12.4 mos in AB/MB versus 10.9 mos in BC ( p = 0.75). On Cox regression analysis, region was not significant. A secondary survival analysis by 2ndL regimen demonstrated a median OS of 18.0 mos with GEMNAB versus 14.3 mos GEM ( p < 0.01). Conclusions: In our population-based comparison of APC pts treated with 1stL FFOX, survival outcomes were comparable regardless of publicly funded access to 2ndL GEMNAB versus GEM. OS by regimen favored 2ndL GEMNAB, but patient selection may be largely responsible for this difference. Randomized trials are needed to demonstrate the benefit of GEMNAB post-FFOX in APC.


2020 ◽  
Author(s):  
Chao Tang ◽  
Ruiliang Wang ◽  
Hengyuan Xu ◽  
Hailong Zhang

Abstract PurposeThe treatment of osteosarcoma of the spine remains controversial. Our aim is to explore the treatment of patients with spinal osteosarcoma.MethodsWe analyzed the date collected 727 spinal osteosarcoma patients from the Surveillance Epidemiology and End Results (SEER) databases between 1973 and 2015. X-tile software was performed to find the optimal cut-off values of age and economic income. Univariate and Multivariate Cox analyses were used to identify the independent prognostic factors. Logistic regression model was conducted to clear the factors associated to surgical compliance; Kaplan-Meier estimator method was adopted to analyze the Overall survival (OS) and Cancer-specific survival (CSS).ResultsAmong 727 eligible spinal osteosarcoma patients, 370 (50.9%) patients received surgical treatment, 357 (49.1%) cases without surgery. There were significant differences in the effects of age at diagnosis, SEER historic stage and tumor grade on surgical treatment (All P < 0.05). Surgery was an independent prognostic factor for OS and CSS of spinal osteosarcoma patients. Spinal osteosarcoma patients undergone surgery group showed favorable survival than the other group.ConclusionsSurgery can provide survival benefits for patients with osteosarcoma of the spine. Spinal osteosarcoma patients with undergone surgery have favorable survival and surgery can become a suitable treatment for patients.


2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 485-485
Author(s):  
Jackson Chu ◽  
Ozge Goktepe ◽  
Winson Y. Cheung

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.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1093-1093
Author(s):  
Hee Jeong Kim ◽  
Seon-Ok Kim ◽  
Rachel A. Freedman ◽  
Ann H. Partridge ◽  
Otto Metzger-Filho

1093 Background: The survival outcomes of postmenopausal women with invasive lobular carcinoma (ILC) are similar to invasive ductal carcinoma (IDC) when treated with aromatase inhibitor, but inferior when treated with tamoxifen. We sought to investigate the survival outcomes of premenopausal ILC when compared to IDC using a population-based analysis. Methods: We used Surveillance, Epidemiology, and End Results data (SEER) between 1990 to 2015 to identify premenopausal patients (defined as < 50 years old), diagnosed with stage I to III IDC or ILC. Breast Cancer Specific Survival (BCSS) was assessed using log-rank test and piecewisecox models. Annual hazard of BCCS for hormone receptor positive (ER+) ILC and ER+ IDC were calculated from year 0 to 20 and defined as the proportion of patients with a BCSS event during a 1-year interval. Results: The study includes a total of 170,352 pts diagnosed with either IDC (n = 158,733) and ILC (n = 11,619). 71% of IDC and 95% of ILC pts were ER+. Median age was 44 years old and median follow up was 90 months(IQR 40-151 months). Survival analysis revealed a significant time-dependent effect of histology for BCSS (p < .0001). When compared to IDC, ILC pts had better BCSS in the first 10 years after diagnosis (HR 0.73, 95% CI 0.68-0.78), but worse BCSS outcome after year 10 (HR 1.80, 95% CI 1.59- 2.03). Similar results were observed when adjusting for ER status, histologic grade and stage on multivariate analysis. Among pts ≤ 35 years old(n = 371 ILC; 18086 IDC) survival analysis revealed a non-significant trend towards inferior outcome for ILC compared to IDC throughout the whole follow-up period (HR = 1.2 95% CI 0.96-1.52). Annual hazard of BCCS events showed a peak at year 5 for both IDC and ILC. In the subset of IDC, we noticed a decreasing hazard of BCSS from years 6 through 20. By contrast, in the subset of ILC, we observed higher frequencies of BCSS from years 6-20 when compared to IDC (p < 0.0001). Conclusions: In this population-based analysis, premenopausal ILC had worse BCSS estimates when compared to premenopausal IDC. This is explained by a higher incidence of late events in the subset of ILC when compared to IDC.


PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8512
Author(s):  
Zhi-wen Li ◽  
Miao Zhang ◽  
Yong-jing Yang ◽  
Zi-jun Zhou ◽  
Yan-ling Liu ◽  
...  

Objectives The survival benefit of postmastectomy radiotherapy (PMRT) has not been fully proven in inflammatory breast cancer (IBC). Thus, in the present research, we aimed at elucidating the effects of PMRT on the survival of IBC patients. Methods Eligible patients were collected from the Surveillance, Epidemiology, and End Results (SEER) dataset between 2010 and 2013. The Kaplan-Meier method along with the log-rank test was utilized for the comparison of both the overall survival (OS) andthe cancer-specific survival (CSS) in patients undergoing PMRT or not. Additionally, multivariate survival analysis of CSS and OS were performed using the Cox proportional hazard model. Results In total, 293 eligible cases were identified, with the median follow-up time of 27 months (range: 5–59 months). After propensity score matching (PSM), 188 patients (94 for each) were classified intothe No-PMRT and the PMRT group. Consequently, significantly higher OS rates were detected in the PMRT group compared with the No-PMRT group prior to PSM (P = 0.034), and significantly higher CSS (P = 0.013) and OS (P = 0.0063) rates were observed following PSM. Furthermore, multivariate analysis revealed thatPMRT [CSS (HR: 0.519, 95% CI [0.287–0.939], P = 0.030); OS (HR: 0.480, 95% CI [0.269–0.859], P = 0.013)], as well as Her2+/HR+ subtype, was independent favorable prognostic factors.Besides, black ethnicity, AJCC stage IV and triple-negative subtype were independent unfavorable prognostic factors. Further subgroup analysis revealed that most of the study population could benefit from PMRT, no matter OS or CSS. Conclusions Our findings support that PMRT could improve the survival of IBC patients.


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