A National Cancer Database analysis of the patterns of care for meningeal melanocytoma

2021 ◽  
Author(s):  
Amanda C Tep ◽  
Patrick D Kelly ◽  
Daphne B Scarpelli ◽  
Bailey Bergue ◽  
Shearwood McClelland III ◽  
...  
Keyword(s):  
Overall Survival ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Treatment Patterns ◽  
National Cancer Database ◽  
Regression Analyses ◽  
Database Analysis ◽  
Meningeal Melanocytoma ◽  
Kaplan Meier ◽  
Poor Treatment

Aim: To evaluate demographics, treatment patterns, radiotherapy utilization and patient outcomes in meningeal melanocytomas. Materials & methods: The National Cancer Database was queried for meningeal melanocytomas diagnosed in 2002–2016. The effects of demographic, clinical and treatment variables were determined via Kaplan–Meier log-rank and Cox regression analyses. Results: The median and 5-year overall survival were 57.46 months and 48%, respectively. Patients earning ≥ $48K showed improved survival (p = 0.0319). Radiotherapy and chemotherapy were utilized in 37.7 and 9% of patients, respectively. Conclusion: Income significantly affected survival. Surgery remains the mainstay approach. Radiotherapy was delivered in more than one-third of patients but did not impact survival. However, further analyses were limited by poor treatment modality information in the database.

Commission on Cancer CP3R Compliance Rates for Treatment of Patients With Triple Negative and HER2+ Breast Cancer: A National Cancer Database Analysis

2021 ◽  
pp. 000313482110516
Author(s):  
Srivarshini C. Mohan ◽  
Joshua Tseng ◽  
Marissa Srour ◽  
Alice Chung ◽  
Ashley Marumoto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Quality Care ◽  
Private Insurance ◽  
National Cancer Database ◽  
Database Analysis ◽  
Her2 Breast Cancer ◽  
Academic Hospitals ◽  
Multi Agent

Background Cancer Program Practice Profile Reports (CP3R) metrics were released by the Commission on Cancer to provide standards for high-quality care. One metric is the recommendation of combination chemotherapy or chemo-immunotherapy (CIT) within 120 days of diagnosis for women under 70 with AJCC T1cN0M0 or Stage IB-III HER2+ or hormone receptor negative breast cancer ([Multi-agent chemotherapy] MAC). Our study assesses national concordance rates for MAC and CIT. Methods The National Cancer Database was queried from 2004-2014. Results 122,045 patients met criteria, of whom treatment for 101,800 (83.4%) patients was concordant with MAC and CIT. Treatment concordance increased from 75.7% in 2004 to 89.5% in 2014. For HER2+ patients, use of CIT treatment downtrended with progression of pathological stage, from 70.1% (stage I) to 58.1% (stage III). Mean overall survival of patients whose treatment was concordant with MAC and CIT was longer than that of patients who were non-concordant (146.6 vs 143.8 months, P <.01). On Cox regression, there was a survival benefit for concordant patients who were treated at academic hospitals (HR .89, 95% CI 0.802-.976) and had private insurance (HR .76, 95% CI 0.65-.89). Conclusion Compliance with MAC and CIT has improved over the past decade and is associated with a significant improvement in overall survival.

Extent of lymph node resection and effect on pancreatic cancer overall survival.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 682-682
Author(s):  
Brian Cox ◽  
Nicholas Manguso ◽  
Humair Quadri ◽  
Jessica Crystal ◽  
Katelyn Mae Atkins ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Logistic Regression ◽  
Lymph Node ◽  
Cox Regression ◽  
Survival Curve ◽  
Regression Analyses ◽  
Kaplan Meier ◽  
The Impact ◽  
Meier Survival Curve

682 Background: Lymph node (LN) metastases affect overall survival (OS) in pancreatic cancer (PC). However, a LN sampling threshold does not exist. We examined the impact of nodal sampling on overall survival (OS). Methods: Patients with Stage I-III PC ≥55 years old who underwent curative resection from 2004-2016 were identified from the National Cancer Database (NCDB). After adjusting for age, gender, grade, stage, and Charlson-Deyo score, multiple binomial logistic regression analyses assessed the impact of the LN ratio (LNR) on OS. LNR was defined as the number of positive LN over the number of LN examined. Regression analyses, a Cox-Regression, and a Kaplan-Meier survival curve assessed how many LN should be sampled. Results: A total of 13,673 patients, median age 69 years (55-90), were included. Most were Caucasian (86.6%) males with Charlson-Deyo scores ≤ 1 (90.3%) and moderately to poorly differentiated PC (90.1%). Median number of LN examined was 15 (1-75) with a median of 1 positive LN (0-35). As expected, increased number of positive LNs was associated with reduced OS, p < 0.001. After data normalization, an increasing LNR was associated with a 12-fold likelihood of death [OR: 11.9, p < 0.001 (CI 6.0, 23.7)]. Subsequent regression models established evaluation of ≥ 16 LNs as the greatest predictor of OS. A regression model evaluating < or ≥ 16 lymph nodes was performed to ascertain the effects of age, gender, ethnicity, grade, stage, and LN examined on OS. The logistic regression model correctly classified 74.5% of cases with a specificity of 99.6% (p < 0.001). Examination of < 16 LN, Caucasian race, grade, stage, and higher Charlson-Deyo scores were significantly associated with decreased OS. If ≥ 16 LNs were examined, patients had a 1.5-fold likelihood of better OS, p < 0.001 (CI 1.4, 1.6). An adjusted Cox Regression showed increased HR of 1.2, p < 0.001 (CI 1.1, 1.2) and an unadjusted Kaplan Meier survival curve predicted ≥ 16 LN examined are associated with an increase in OS of 2.8 months [log-rank: 32.0, p < 0.001]. Conclusions: Patients undergoing curative intent resection for PC should have adequate nodal sampling. Stratification of patients by LNR may provide useful information of OS. Examination of ≥ 16 LNs impacts OS in patients with Stage I-III PC.

scholarly journals Survival after Combined Hepatic Metastasectomy and Chemotherapy in Patients with Concurrent Hepatic and Extrahepatic Colorectal Metastases: a SEER Database Analysis

2020 ◽  
Author(s):  
Inas Uthman ◽  
Ahmed M Fouad ◽  
Islam Khaled ◽  
Mohammed Faisal
Keyword(s):  
Alaska Native ◽  
Cox Regression ◽  
Hepatic Metastases ◽  
Colorectal Metastases ◽  
Seer Database ◽  
Regression Analyses ◽  
Database Analysis ◽  
Kaplan Meier ◽  
The Us ◽  
Colorectal Cancer Patients

Abstract PurposeColorectal cancer is the second leading cause of death among all cancers worldwide. Hepatic metastases exist in approximately 50% of colorectal cancer patients. The purpose of this study was to assess the effect of combined hepatic metastasectomy and chemotherapy on overall survival in patients with concurrent hepatic and extrahepatic disease.MethodsA total of 2533 patients from the US Surveillance, Epidemiology, and End Results (SEER) database with concurrent colorectal liver metastasis (CRLM) and extrahepatic disease (EHD) between January 1, 2010, and December 31, 2014, were retrieved. Survival analysis with Kaplan-Meier and Cox regression analyses was performed to assess the effect of combined hepatic metastasectomy and chemotherapy on 5-year survival.ResultsTwo hundred and fourteen (8.4%) patients underwent combined hepatic metastasectomy and chemotherapy. The median survival time among patients who underwent combined hepatic metastasectomy and chemotherapy was significantly higher than that of patients who underwent chemotherapy alone (24 vs. 21 months; p < 0.0001). Furthermore, older age at diagnosis (≥ 60 years), American Indian/Alaska Native race, primary sites at the rectosigoid colon, sigmoid colon, and descending colon, grade III, and the presence of bone metastases were all significantly associated with higher 5-year mortality. Patients who underwent combined hepatic metastasectomy and chemotherapy were significantly associated with 22.2% less 5-year mortality than patients who received chemotherapy alone.ConclusionCombined hepatic metastasectomy with chemotherapy in CRLM patients with EHD yields better survival than chemotherapy alone.

Stage I ovarian immature teratomas: Is there a role for chemotherapy?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5523-5523
Author(s):  
John K. Chan ◽  
Emily B Rosenfeld ◽  
Austin Blake Gardner ◽  
Lejla Delic ◽  
Daniel Stuart Kapp
Keyword(s):  
Overall Survival ◽  
Regression Models ◽  
Cox Regression ◽  
Racial Group ◽  
Stage I ◽  
National Cancer Database ◽  
Fertility Sparing Surgery ◽  
Kaplan Meier ◽  
Fertility Sparing ◽  
The Impact

5523 Background: To determine the impact of chemotherapy on survival of patients with stage I ovarian immature teratomas. Methods: Data obtained from the National Cancer Database from 2004-2013. Kaplan-Meier methods and multivariate Cox regression models were used for statistical analyses. Results: Of 888 patients (median age 24 years), 76%, 7%, 15%, 3% were stages I, II, III, and IV, respectively. 27%, 28%, 38%, and 8% had grades 1, 2, 3 and 4. The predominant racial group was White (50%) and remainder Black (19%), Hispanic (16%), Asian (6%) and other (9%). 64% had fertility sparing surgery and 55% received chemotherapy. For all patients, 5 year survival was over 90%. Chemotherapy did not change the 5 year survival for stage I or stage II disease (p = 0.35 and p = 0.69, respectively). However, chemotherapy improved 5 year survival from 59% to 76% in stages III-IV (p < 0.01). When controlling for other factors, older age (HR 3.2, p < 0.01), stages II and III-IV (HR 6.0, p < 0.01; HR 10.6, p < 0.01) and grades 3-4 (HR 15.3, p < 0.01) had worse survival. In a subset analysis of stage I patients chemotherapy did not improve 5 year survival of those with stage I grade 1 (p = 0.75) but chemotherapy did improved the survival of those with stage I grade 2 disease from 85% to 99% (p = 0.04). Conclusions: The overall survival of patients with immature teratomas is excellent. In patients with stage I grade 2 or higher disease chemotherapy was associated with an improved overall survival.

scholarly journals Allele frequency deviation (AFD) as a new prognostic model to predict overall survival in lung adenocarcinoma (LUAD)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aisha Al-Dherasi ◽  
Yuwei Liao ◽  
Sultan Al-Mosaib ◽  
Rulin Hua ◽  
Yichen Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Adenocarcinoma ◽  
Allele Frequency ◽  
Prognostic Model ◽  
Cox Regression ◽  
Training Group ◽  
Regression Analyses ◽  
Prognostic Tool ◽  
Risk Of Death ◽  
Kaplan Meier

Abstract Background Lung adenocarcinoma (LUAD) remains one of the world’s most known aggressive malignancies with a high mortality rate. Molecular biological analysis and bioinformatics are of great importance as they have recently occupied a large area in the studies related to the identification of various biomarkers to predict survival for LUAD patients. In our study, we attempted to identify a new prognostic model by developing a new algorithm to calculate the allele frequency deviation (AFD), which in turn may assist in the early diagnosis and prediction of clinical outcomes in LUAD. Method First, a new algorithm was developed to calculate AFD using the whole-exome sequencing (WES) dataset. Then, AFD was measured for 102 patients, and the predictive power of AFD was assessed using Kaplan–Meier analysis, receiver operating characteristic (ROC) curves, and area under the curve (AUC). Finally, multivariable cox regression analyses were conducted to evaluate the independence of AFD as an independent prognostic tool. Result The Kaplan–Meier analysis showed that AFD effectively segregated patients with LUAD into high-AFD-value and low-AFD-value risk groups (hazard ratio HR = 1.125, 95% confidence interval CI 1.001–1.26, p = 0.04) in the training group. Moreover, the overall survival (OS) of patients who belong to the high-AFD-value group was significantly shorter than that of patients who belong to the low-AFD-value group with 42.8% higher risk and 10% lower risk of death for both groups respectively (HR for death = 1.10; 95% CI 1.01–1.2, p = 0.03) in the training group. Similar results were obtained in the validation group (HR = 4.62, 95% CI 1.22–17.4, p = 0.02) with 41.6%, and 5.5% risk of death for patients who belong to the high and low-AFD-value groups respectively. Univariate and multivariable cox regression analyses demonstrated that AFD is an independent prognostic model for patients with LUAD. The AUC for 5-year survival were 0.712 and 0.86 in the training and validation groups, respectively. Conclusion AFD was identified as a new independent prognostic model that could provide a prognostic tool for physicians and contribute to treatment decisions.

Does bladder urothelial cancer behave differently in young patients?

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 294-294
Author(s):  
Z. Wang ◽  
Y. Li ◽  
H. Lu ◽  
X. Zeng ◽  
Q. Zhuang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Young Adults ◽  
Tumor Size ◽  
Urothelial Cancer ◽  
Cox Regression ◽  
Young Patients ◽  
High Grade ◽  
Regression Analyses ◽  
Kaplan Meier ◽  
Increasing Trend

294 Background: From 2000 to 2008, the incidence of bladder urothelial cancer in the young adults was diagnosed at an increasing trend at the Tongji Hospital, China. To investigate whether bladder urothelial cancer in patients under the age of 40 years behaves significantly differently from the bladder urothelial cancer in elder patients. Methods: From 1994 to 2008, the records of 4,568 patients with pathological diagnosis of bladder urothelial cancer presented to the Tongji Hospital were retrospectively reviewed. 82 patients were younger than 40 at the time of diagnosis. The clinicopathologic parameters were compared between this group and a serial of 164 older patients during the same time period. The Kaplan-Meier and Cox regression analyses were performed for the survival analysis. Results: 2.05% of patients with pathological diagnosis of bladder urothelial cancer presented to the Tongji Hospital were younger than 40 years (median age 32.93). Compared to the older group, young adults group had a lower sex ratio (male-to-female ratio, 3.4:1vs.6.5:1, p<0.05); much less likely with advanced stages (the percentage of invasive tumor, i.e., T1 or above, 28.1% vs. 52.4%, p<0.01); less with a high grade (the percentage of high grade tumor, 14.6% vs. 22.6%, p<0.05); lower recurrence rate (23.2% vs. 39.6%, p<0.05); less with big tumor size (the percent of tumor size greater than 3 cm, 18.3% vs. 22.0%, p<0.05); and less with multifocal (12.2% vs. 50.6%, p<0.01). Kaplan-Meier method and the log-rank test showed a significantly better cancer specific and overall survival for the group of young patients (p<0.01). The multivariate Cox regression analyses showed the following criteria were independent prognostic factors of overall survival: bladder tumor multiplicity, size greater than 3 cm, T2 or above stage, and high grade. Conclusions: Despite an increasing trend of diagnosis, both the pathologic features and clinical outcomes were significantly better in the young patients with bladder urothelial cancer when compared to their elderly counterparts. These findings suggested that more consevertive management approaches may be warranted for this group of patients even under the circumstances of extensive bladder involvement. No significant financial relationships to disclose.

Impact of colonoscopically missed cancers on patient outcomes.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 404-404
Author(s):  
Anand Govindarajan ◽  
Linda Rabeneck ◽  
Jill Tinmouth ◽  
Lawrence Frank Paszat ◽  
Nancy Baxter
Keyword(s):  
Overall Survival ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Surgical Complication ◽  
Time Windows ◽  
Multivariable Analysis ◽  
Population Based ◽  
Binary Outcomes ◽  
Emergency Presentation ◽  
Kaplan Meier

404 Background: There is increasing recognition of the potential for cancers to be missed on colonoscopy, but little is known about their outcomes. The objective of this study was to evaluate the outcomes of missed cancers relative to those detected by colonoscopy. Methods: We conducted a retrospective population-based cohort study, including all patients diagnosed with colorectal cancer (CRC) in Ontario, Canada from 2003-2009, who had undergone a colonoscopy within 36 months prior to diagnosis. Using previously defined time windows, we defined detected cancers as those diagnosed within 6 months of index colonoscopy and missed cancers as those diagnosed between 6 and 36 months after index colonoscopy. Patient and tumor factors were recorded as covariates. The primary outcome was overall survival, with secondary outcomes of resection rate, emergency presentation, and surgical complication rate. Logistic regression was used to analyze binary outcomes and Kaplan-Meier and Cox regression analyses were used for survival outcomes. Results: Overall, 30,475 patients were included in the study, with 2,804 being classified as having a missed cancer. Factors associated with missed cancers included colonic location (vs. rectum), older age, female sex, rural residence, and Charlson comorbidity score. Absolute 5-year overall survival was significantly lower in missed compared to detected cancers (60.8% vs. 68.3%, difference: 7.5%, p < 0.0001). In multivariable analysis, patients with missed cancers had a 22% higher hazard of death (HR: 1.22, 95% CI: 1.15 to 1.30, p < 0.0001). Patients with missed cancers were significantly more likely to present emergently with obstruction, bleeding or perforation (OR: 2.86, 95% CI: 2.56 to 3.13, p < 0.001) and were significantly less likely to have their tumors surgically resected (OR: 0.61, 95% CI: 0.55 to 0.67, p < 0.001). Conclusions: CRCs that are missed on initial colonoscopy are associated with markedly inferior patient outcomes, with a higher risk of emergent presentation, a lower likelihood of surgical resection, and most notably a significantly worse overall survival. These findings reinforce the critical importance of studying and improving quality measures of CRC screening to improve patient outcomes.

Adjuvant radiotherapy in carcinomas of the uterine cervix: the prognostic value of hemoglobin levels

2005 ◽  
Vol 15 (2) ◽  
pp. 285-291 ◽  
Author(s):  
K. MÜNSTEDT ◽  
P. Johnson ◽  
M. K. Bohlmann ◽  
M. Zygmunt ◽  
R. Von Georgi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cervical Carcinoma ◽  
Prognostic Value ◽  
Cox Regression ◽  
Tumor Stage ◽  
Regression Analyses ◽  
Primary Surgery ◽  
Kaplan Meier ◽  
Advanced Cervical Carcinoma ◽  
Primary Radiotherapy

Anemia has been associated with a poorer treatment response and reduced survival in women undergoing primary radiotherapy (RT) or radiochemotherapy for advanced cervical carcinoma. This study aimed to determine the influence of anemia on outcome in patients with cervical carcinoma undergoing adjuvant RT. Medical records were reviewed for 183 cervical cancer patients who had received adjuvant RT because of risk factors after radical surgery (n = 109) or inadequate primary surgery (simple hysterectomy; n = 74). Kaplan–Meier and Cox regression analyses were used to study hemoglobin levels before and during adjuvant RT in relation to recurrence-free and overall survival. Hemoglobin values ≥11 g/dL were considered normal, while those <11 g/dL indicated anemia. Hemoglobin levels before RT influenced significantly overall survival and recurrence-free survival across the whole group (overall survival—log rankall patients = 7.5; df = 1; P = 0.006). However, subgroup analysis showed that the observed difference was mainly due to the group of women who had undergone inadequate primary surgery (overall survival—log rankinadequate surgery = 10.8; df = 1; P = 0.001). Multifactorial regression analyses comparing hemoglobin before RT with grading and tumor stage confirmed the prognostic value of hemoglobin values. Maintaining normal hemoglobin values before and during adjuvant RT seems to be important, especially in patients who have had inappropriate simple hysterectomy, which may resemble a therapeutic situation.

Survival Outcomes for Induction vs Adjuvant Chemotherapy in Squamous Cell Carcinoma of the Maxillary Sinus

2018 ◽  
Vol 160 (4) ◽  
pp. 658-663 ◽  
Author(s):  
Phoebe Kuo ◽  
Sina J. Torabi ◽  
Dennis Kraus ◽  
Benjamin L. Judson
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Maxillary Sinus ◽  
Induction Chemotherapy ◽  
Squamous Cell ◽  
Cox Regression ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Log Rank Test ◽  
Kaplan Meier

Objective In advanced maxillary sinus cancers treated with surgery and radiotherapy, poor local control rates and the potential for organ preservation have prompted interest in the use of systemic therapy. Our objective was to present outcomes for induction compared to adjuvant chemotherapy in the maxillary sinus. Study Design Secondary database analysis. Setting National Cancer Database (NCDB). Subjects and Methods In total, 218 cases of squamous cell maxillary sinus cancer treated with surgery, radiation, and chemotherapy between 2004 and 2012 were identified from the NCDB and stratified into induction chemotherapy and adjuvant chemotherapy cohorts. Univariate Kaplan-Meier analyses were compared by log-rank test, and multivariate Cox regression was performed to evaluate overall survival when adjusting for other prognostic factors. Propensity score matching was also used for further comparison. Results Twenty-three patients received induction chemotherapy (10.6%) and 195 adjuvant chemotherapy (89.4%). The log-rank test comparing induction to adjuvant chemotherapy was not significant ( P = .076). In multivariate Cox regression when adjusting for age, sex, race, comorbidity, grade, insurance, and T/N stage, there was a significant mortality hazard ratio of 2.305 for adjuvant relative to induction chemotherapy (confidence interval, 1.076-4.937; P = .032). Conclusion Induction chemotherapy was associated with improved overall survival in comparison to adjuvant chemotherapy in a relatively small cohort of patients (in whom treatment choice cannot be characterized), suggesting that this question warrants further investigation in a controlled clinical trial before any recommendations are made.

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