Trends in Tumor Site-Specific Survival of Bone Sarcomas from 1980 to 2018: A Surveillance, Epidemiology and End Results-Based Study

Objectives: As diagnosis and treatment guidelines for bone sarcomas continue updating, it is important to examine whether, when, and which kinds of patients have had a survival improvement over the last four decades. Methods: This cohort study included 9178 patients with primary bone and joint sarcomas from 1 January 1980 to 31 December 2018 using data from Surveillance, Epidemiology and End Results (SEER)-9 Registries. The follow-up period was extended to November 2020. Patients were divided by decade into four time periods: 1980–1989, 1990–1999, 2000–2009, and 2010–2018. The primary endpoint was bone sarcomas-specific mortality (CSM). The 5-year bone sarcomas-specific survival (CSS) rate was determined stratified by demographic, neoplastic, temporal, economic, and geographic categories. The associations between time periods and CSM were examined using a multivariable Cox regression model, with reported hazard ratio (HR) and 95% confidence interval (CI). Results: The 5-year CSS rate for bone sarcomas was 58.7%, 69.9%, 71.0%, and 69.2%, in the 1980s, 1990s, 2000s, and 2010s, respectively. Older age, male gender, tumor sites at pelvic bones, sacrum, coccyx and associated joints, as well as vertebral column, osteosarcoma and Ewing tumor, and residence in non-metropolitan areas were independently associated with higher CSM risk. After adjusting for the covariates above, patients in the 1990s (HR = 0.74, 95% CI = 0.68–0.82), 2000s (HR = 0.71, 95% CI = 0.65–0.78), and 2010s (HR = 0.68, 95% CI = 0.62–0.76) had significantly lower CSM risks than patients in the 1980s. However, patients in the 2000s and 2010s did not have lower CSM risks than those in the 1990s (both p > 0.05). Conclusions: Although bone sarcomas survival has significantly improved since 1990, it almost halted over the next three decades. Bone sarcomas survival should improve over time, similar to common cancers. New diagnostic and therapeutic strategies such as emerging immune and targeted agents are warranted to overcome this survival stalemate.

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Development of a Multivariable Prediction Model to Identify Patients Unlikely to Complete a Colonoscopy Following an Abnormal FIT Test in Community Clinics

10.21203/rs.3.rs-23641/v2 ◽

2020 ◽

Author(s):

Amanda Petrik ◽

Erin Keast ◽

Eric Johnson ◽

David H. Smith ◽

Gloria D. Coronado

Keyword(s):

Prediction Model ◽

Cox Regression ◽

Outreach Program ◽

Risk Levels ◽

C Statistic ◽

Clinic Site ◽

Flu Vaccine ◽

Using Data ◽

Priority Populations

Abstract Background: Colorectal cancer (CRC) is the 2nd leading cancer killer in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low. We developed a multivariable prediction model using data available in the electronic health record to assess the probability of patients obtaining a colonoscopy following an abnormal FIT test. Methods: To assess the probability of obtaining a colonoscopy, we used Cox regression to develop a risk prediction model among a retrospective cohort of patients with an abnormal FIT result and a year of follow-up data. Results: Of 1596 patients with an abnormal FIT result, 556 (34.8%) had a recorded colonoscopy within 6 months. The model shows adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (bootstrap-corrected C-statistic > 0.63). The refined model included 8 variables: age, race, insurance, GINI income inequality, long term anticoagulant use, receipt of a flu vaccine in the past year, frequency of missed clinic appointments, and clinic site. Probability of obtaining a follow-up colonoscopy within 6 months varied across quintiles; patients in the lowest quintile had an estimated 18% chance, whereas patients in the top quintile had a greater than 55% chance of obtaining a follow-up colonoscopy. Conclusions: Knowing who is unlikely to follow-up on an abnormal FIT test could help identify patients who need an early intervention aimed at complete a follow-up colonoscopy. Trial registry: This trial was registered at ClinicalTrials.gov (NCT01742065) on December 5, 2012. The protocol is available.

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Predictive value of AZGP1 following radical prostatectomy for prostate cancer: a cohort study and meta-analysis

Journal of Clinical Pathology ◽

10.1136/jclinpath-2019-205940 ◽

2019 ◽

Vol 72 (10) ◽

pp. 696-704 ◽

Cited By ~ 1

Author(s):

Gitte Kristensen ◽

Kasper Drimer Berg ◽

Birgitte Grønkær Toft ◽

Hein Vincent Stroomberg ◽

Rosalie Nolley ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Cox Regression ◽

Meta Analysis ◽

Model Performance ◽

Biochemical Failure ◽

Castration Resistant ◽

Specific Mortality ◽

Tissue Biomarker

AimsZinc-alpha 2-glycoprotein (AZGP1) is a promising tissue biomarker to predict outcomes in men undergoing treatment for localised prostate cancer (PCa). We aimed to examine the association between AZGP1 expression and the endpoints: risk of biochemical failure (BF), initiating castration-based treatment, developing castration-resistant PCa (CRPC) and PCa-specific mortality following radical prostatectomy (RP).MethodsThe study included a prospective cohort of 302 patients who underwent RP for PCa from 2002 to 2005. AZGP1 expression was analysed using immunohistochemistry on tissue microarray RP specimens and was scored semiquantitively as low or high expression. Risk of all endpoints was analysed using stratified cumulative incidences and cause-specific Cox regression, and validated with receiver operating curves, calibration and discrimination in competing-risk analyses. A meta-analysis was performed including previous studies investigating AZGP1 expression and risk of BF following RP.ResultsMedian time of follow-up was 14.0 years. The cumulative incidence of all endpoints was significantly higher in patients with low AZGP1 expression compared with patients with high AZGP1 expression (p<0.001). In a multivariate analysis, low AZGP1 expression increases the risk of BF (HR 2.7; 95% CI 1.9 to 3.8; p<0.0001), castration-based treatment (HR 2.2; 95% CI 1.2 to 4.2; p=0.01) and CRPC (HR 2.3; 95% CI 1.1 to 5.0; p=0.03). Validation showed a low risk of prediction error and a high model performance for all endpoints. In a meta-analysis, low AZGP1 was associated with BF (HR 1.7; 95% CI 1.2 to 2.5).ConclusionsLow AZGP1 expression is associated with the risk of aggressive time-dependent outcomes in men undergoing RP for localised PCa.

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Primary bone sarcomas in patients over 40 years of age: A retrospective study using data from the Bone Tumor Registry of Japan

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.03.008 ◽

2017 ◽

Vol 22 (4) ◽

pp. 749-754 ◽

Cited By ~ 4

Author(s):

Akihito Nagano ◽

Daichi Ishimaru ◽

Yutaka Nishimoto ◽

Haruhiko Akiyama ◽

Akira Kawai

Keyword(s):

Retrospective Study ◽

Bone Tumor ◽

Tumor Registry ◽

Bone Sarcomas ◽

Primary Bone ◽

Using Data ◽

Over 40 Years

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Long-term exposure to particulate air pollution and black carbon in relation to natural and cause-specific mortality: a multicohort study in Sweden

BMJ Open ◽

10.1136/bmjopen-2020-046040 ◽

2021 ◽

Vol 11 (9) ◽

pp. e046040

Author(s):

Johan Nilsson Sommar ◽

Eva M Andersson ◽

Niklas Andersson ◽

Gerd Sallsten ◽

Leonard Stockfelt ◽

...

Keyword(s):

Air Pollution ◽

Black Carbon ◽

Cox Regression ◽

Random Effect ◽

Mortality Data ◽

Natural Mortality ◽

Specific Mortality ◽

Cvd Mortality

ObjectivesTo estimate concentration–response relationships for particulate matter (PM) and black carbon (BC) in relation to mortality in cohorts from three Swedish cities with comparatively low pollutant levels.SettingCohorts from Gothenburg, Stockholm and Umeå, Sweden.DesignHigh-resolution dispersion models were used to estimate annual mean concentrations of PM with aerodynamic diameter ≤10 µm (PM10) and ≤2.5 µm (PM2.5), and BC, at individual addresses during each year of follow-up, 1990–2011. Moving averages were calculated for the time windows 1–5 years (lag1–5) and 6–10 years (lag6–10) preceding the outcome. Cause-specific mortality data were obtained from the national cause of death registry. Cohort-specific HRs were estimated using Cox regression models and then meta-analysed including a random effect of cohort.ParticipantsDuring the study period, 7 340 cases of natural mortality, 2 755 cases of cardiovascular disease (CVD) mortality and 817 cases of respiratory and lung cancer mortality were observed among in total 68 679 individuals and 689 813 person-years of follow-up.ResultsBoth PM10 (range: 6.3–41.9 µg/m3) and BC (range: 0.2–6.8 µg/m3) were associated with natural mortality showing 17% (95% CI 6% to 31%) and 9% (95% CI 0% to 18%) increased risks per 10 µg/m3 and 1 µg/m3 of lag1-5 exposure, respectively. For PM2.5 (range: 4.0–22.4 µg/m3), the estimated increase was 13% per 5 µg/m3, but less precise (95% CI −9% to 40%). Estimates for CVD mortality appeared higher for both PM10 and PM2.5. No association was observed with respiratory mortality.ConclusionThe results support an effect of long-term air pollution on natural mortality and mortality in CVD with high relative risks also at low exposure levels. These findings are relevant for future decisions concerning air quality policies.

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Biomarker-assessed passive smoking in relation to cause-specific mortality: pooled data from 12 prospective cohort studies comprising 36 584 individuals

10.1101/2020.06.04.20121111 ◽

2020 ◽

Author(s):

Elisabeth Kvaavik ◽

Aage Tverdal ◽

George David Batty

Keyword(s):

Cohort Studies ◽

Passive Smoking ◽

Pooled Data ◽

Hazard Ratios ◽

Specific Mortality ◽

Salivary Cotinine ◽

Using Data ◽

Biochemical Assessment ◽

Combined Data

Aims: While investigators have typically quantified the health risk of passive smoking by utilising self-reported exposure, prospective studies with objective ascertainment, which are less liable to measurement error, are rare. Using data pooling, we examined the relation of a biochemical assessment of passive smoking, salivary cotinine, with mortality from a range of causes. Methods: We combined data from twelve cohort studies from England and Scotland initiated between 1998 and 2008. Study members were linked to national death registries. A total of 36 584 men and women aged 16 to 85 years of age reported that they were non-smoking at baseline, provided baseline salivary cotinine, and consented to mortality record linkage. Results: A mean of 8.1 years of mortality follow-up of 36 584 non-smokers (16 792 men and 19 792 women) gave rise to 2367 deaths (775 from cardiovascular disease, 780 from all cancers, and 289 from smoking-related cancers). After controlling for a range of covariates, a 10 ng/ml increase in salivary cotinine level was related to an elevated risk of total (hazard ratios; 95% confidence interval: 1.46; 1.16, 1.83), cardiovascular (1.41; 0.96, 2.09), cancer (1.49; 1.00, 2.22) and smoking-related cancer mortality (2.92; 1.77, 4.83). Conclusions: Passive smoking assessed biomedically was a risk factor for a range of health outcomes known to be causally linked to active smoking.

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COVID-19 vaccine effectiveness against laboratory confirmed symptomatic SARS-CoV-2 infection, COVID-19 related hospitalizations and deaths, among individuals aged 65 years or more in Portugal: a cohort study based on data-linkage of national registries February-September 2021

10.1101/2021.12.10.21267619 ◽

2021 ◽

Author(s):

Ausenda Machado ◽

Irina Kislaya ◽

Ana Paula Rodrigues ◽

Duarte Sequeira ◽

Joao Lima ◽

...

Keyword(s):

Cox Regression ◽

Viral Vector ◽

Vaccine Effectiveness ◽

Time Dependent ◽

Unique Identifier ◽

Symptomatic Infection ◽

Age Cohorts ◽

Electronic Health ◽

Using Data

Background: Using data from electronic health registries, this study intended to estimate the COVID-19 vaccine effectiveness in the population aged 65 years and more, against symptomatic infection, COVID-19 related hospitalizations and deaths, overall and by time since complete vaccination. Methods: We stablished a cohort of individuals aged 65 and more years old, resident in Portugal mainland, using the National Health Service unique identifier User number to link eight electronic health registries. Outcomes included were symptomatic SARS-CoV-2 infections, COVID-19 related hospitalizations or deaths. The exposures of interest were the mRNA vaccines (Cominarty or Spikevax) and the viral vector Vaxzevria vaccine. Complete scheme vaccine effectiveness (VE) was estimated as one minus the confounder adjusted hazard ratio, for each outcome, estimated by time-dependent Cox regression with time dependent vaccine exposure. Results: For the cohort of individuals aged 65-79 years, complete scheme VE against symptomatic infection varied between 43% (Vaxzevria) and 65% (mRNA vaccines). This estimate was slightly lower in the ≥80 year cohort (53% for mRNA vaccines. VE against COVID-19 hospitalization varied between 89% (95%CI: 52-94) for Vaxzevria and 95% (95%CI: 93-97) for mRNA vaccines for the cohort aged 65-79 years and was 76% (95%CI: 67-83) for mRNA vaccines in the ≥80 year cohort. High VE against COVID-19 related deaths were estimated, for both vaccine types, 95% and 81% for the 65-79 years and the ≥80 year cohort, respectively. We observed a significant waning of VE against symptomatic infection, with VE estimates reaching approximately 34% for both vaccine types and cohorts. Significant waning was observed for the COVID-19 hospitalizations in the ≥80 year cohort (decay from 83% 14-41 days to 63% 124 days after mRNA second dose). No significant waning effect was observed for COVID-19 related deaths in the period of follow-up of either cohorts. Conclusions: In a population with a high risk of SARS-CoV-2 complications, we observed higher overall VE estimates against more severe outcomes for both age cohorts when compared to symptomatic infections. Considering the analysis of VE according to time since complete vaccination, the results showed a waning effect for both age cohorts in symptomatic infection and COVID-19 hospitalization for the 80 and more yo cohort.

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751Investigation of the obesity paradox in kidney cancer: mystifying association or myth?

International Journal of Epidemiology ◽

10.1093/ije/dyab168.274 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Alicia Heath ◽

Joanna Clasen ◽

Elio Riboli ◽

Ghislaine Scelo ◽

David Muller

Keyword(s):

Kidney Cancer ◽

Cox Regression ◽

Obesity Paradox ◽

Hazard Ratios ◽

Increased Risk ◽

Incidence And Mortality ◽

All Cause Mortality ◽

Using Data ◽

Restricted Cubic Splines

Abstract Background An “obesity paradox” has been reported in kidney cancer, whereby obesity is a risk factor, yet appears to be associated with better survival. To evaluate this paradox, we investigated the association between pre-diagnostic adiposity and renal cell carcinoma (RCC) incidence and mortality. Methods Using data from 363,521 men and women in the European Prospective Investigation into Cancer and Nutrition (EPIC), Cox regression models yielded confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for RCC incidence and mortality in relation to BMI modelled continuously and using restricted cubic splines. RCC-specific and all-cause mortality were evaluated among cases. Results During a mean follow-up of 14.9 years, 936 incident RCC cases were identified, 383 of whom died (278 due to RCC). Each 5 kg/m2 increment in BMI was associated with 27% and 46% higher RCC incidence and mortality (HRs=1.27, 95% CI 1.18-1.37 and 1.46, 95% CI 1.28-1.66, respectively). Comparing a BMI of 35 with 22 kg/m2, HRs for RCC incidence and mortality were 1.88 (95% CI 1.54-2.30) and 2.37 (95% CI 1.68-3.35), respectively. Among RCC cases, HRs per 5 kg/m2 increment in BMI were 1.22 (95% CI 1.07-1.41) for RCC-specific mortality and 1.18 (95% CI 1.04-1.34) for all-cause mortality. Similar, positive linear associations were evident for waist circumference and waist-to-hip ratio. Conclusions Obesity was associated with increased RCC incidence and mortality, and worse prognosis among cases. Key messages The kidney cancer-obesity paradox does not appear to be real. Higher adiposity is associated with an increased risk of incident and fatal RCC.

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Development of a Multivariable Prediction Model to Identify Patients Unlikely to Complete a Colonoscopy Following an Abnormal FIT Test in Community Clinics

10.21203/rs.3.rs-23641/v1 ◽

2020 ◽

Author(s):

Amanda Petrik ◽

Erin Keast ◽

Eric Johnson ◽

David H. Smith ◽

Gloria D. Coronado

Keyword(s):

Prediction Model ◽

Cox Regression ◽

Outreach Program ◽

Risk Levels ◽

C Statistic ◽

Clinic Site ◽

Flu Vaccine ◽

Using Data ◽

Priority Populations

Abstract Background Colorectal cancer (CRC) is the 2nd leading cancer killer in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low. We developed a multivariable prediction model using data available in the electronic health record to assess the probability of patients obtaining a colonoscopy following an abnormal FIT test.Methods We used Cox regression to develop a risk prediction model among a retrospective cohort of patients with an abnormal FIT result and a year of follow-up data.Results Of 1723 patients with an abnormal FIT result, 699 (40.6%) had a colonoscopy within 1 year and 597 (34.6%) had a recorded colonoscopy within 6 months. The model shows adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (bootstrap-corrected C-statistic > 0.63). The refined model included 8 variables: age, race, insurance, GINI income inequality, long term anticoagulant use, receipt of a flu vaccine in the past year, frequency of missed clinic appointments, and clinic site. Probability of obtaining a follow-up colonoscopy within 6 months varied across quintiles; patients in the lowest quintile had an estimated 18% chance, whereas patients in the top quintile had a greater than 55% chance of obtaining a follow-up colonoscopy.Conclusions Knowing who may be at risk for failing to follow-up on an abnormal FIT test could help identify patients in need of early interventions aimed at completing a colonoscopy.Trial registry This trial was registered at ClinicalTrials.gov (NCT01742065) on December 5, 2012.

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Hypomagnesemia and Cause-specific Mortality in Hemodialysis Patients: 5-year follow-up Analysis

The International Journal of Artificial Organs ◽

10.5301/ijao.5000611 ◽

2017 ◽

Vol 40 (10) ◽

pp. 542-549 ◽

Cited By ~ 10

Author(s):

Gjulsen N. Selim ◽

Goce Spasovski ◽

Liljana Tozija ◽

Ljubica Georgievska-Ismail ◽

Beti Zafirova-Ivanovska ◽

...

Keyword(s):

Cox Regression ◽

Serum Magnesium ◽

Lower Serum ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Specific Mortality ◽

Patient Groups ◽

Cv Disease ◽

Univariate Predictor

Introduction The aim of this prospective study was to evaluate the association between serum magnesium (Mg) and mortality, in particular the cause-specific mortality of Mg and other risk factors in hemodialysis (HD) patients. Methods We studied a cohort of 185 HD patients receiving thrice-weekly HD treatment, on a dialysate Mg concentration of 0.5 mmol/L. We stratified 3 patient groups according to the level of Mg: lower (<1.1 mmol/L), intermediate-reference (1.1 to <1.3 mmol/L), and higher (Mg >1.3 mm/L). Results During the 5-year follow-up, 60 patients died, with cardiovascular (CV) disease as the predominant cause (73.3%). Hazard ratio (HR) for all-cause and CV mortality were 2.55 and 2.67 in the lower versus intermediate Mg group, but there was no significant association between the higher and intermediate Mg group. Univariate Cox regression analysis showed that Mg <1.1 versus 1.1–1.30 mml/L with HR 2.34, was a significant univariate predictor for increased mortality in addition to the Hb <110 g/L, Alb <40 g/L, C-reactive protein (CRP) ≥10 mg/L and brain natriuretic peptide >1,200 pg/mL However, in the multivariate analysis only CRP ≥10 mg/L with HR 3.89 was a significant predictor of mortality. Subgroup analyses showed that among patients with CRP >10 mg/L, HR for all-cause and CV mortality of the lower versus intermediate Mg group were 1.96 and 2.39, respectively, not reaching significance for the higher versus intermediate Mg group. Conversely, there was no association between Mg level and all-cause and CV mortality within these 3 groups among patients with CRP <10 mg/L. Conclusions Lower serum Mg level was significantly associated with an increased all-cause and cardiovascular mortality in HD patients, especially in inflamed patients.

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Peak flow as a predictor of cause-specific mortality in China: results from a 15-year prospective study of ∼170 000 men

International Journal of Epidemiology ◽

10.1093/ije/dyt079 ◽

2013 ◽

Vol 42 (3) ◽

pp. 803-815 ◽

Cited By ~ 11

Author(s):

Margaret Smith ◽

Maigeng Zhou ◽

Lijun Wang ◽

Richard Peto ◽

Gonghuan Yang ◽

...

Keyword(s):

Lung Cancer ◽

Cardiovascular Disease ◽

Cox Regression ◽

Forced Expiratory Volume ◽

Respiratory Mortality ◽

Hazard Ratios ◽

Specific Mortality ◽

Study Population ◽

Log Linear

Abstract Background Forced expiratory volume in one second (FEV1) is inversely associated with mortality in Western populations, but few studies have assessed the associations of peak expiratory flow (PEF) with subsequent cause-specific mortality, or have used populations in developing countries, including China, for such assessments. Methods A prospective cohort study followed ∼170 000 Chinese men ranging in age from 40–69 years at baseline (1990–1991) for 15 years. In the study, height-adjusted PEF (h-PEF), which was uncorrelated with height, was calculated by dividing PEF by height. Hazard ratios (HR) for cause-specific mortality and h-PEF, adjusted for age, area of residence, smoking, and education, were calculated through Cox regression analyses. Results Of the original study population, 7068 men died from respiratory causes (non-neoplastic) and 22 490 died from other causes (including 1591 from lung cancer, 5469 from other cancers, and 10 460 from cardiovascular disease) before reaching the age of 85 years. Respiratory mortality was strongly and inversely associated with h-PEF. For h-PEF ≥ 250 L/min, the association was log-linear, with a hazard ratio (HR) of 1.29 (95% CI: 1.25–1.34) per 100 L/min reduction in h-PEF. The association was stronger but not log-linear for lower values of h-PEF. Mortality from combined other causes was also inversely associated with h-PEF, and the association was log-linear for all values of h-PEF, declining with follow-up, with HRs per 100 L/min reduction in h-PEF of 1.13 (1.10–1.15), 1.08 (1.06–1.11), and 1.06 (1.03–1.08) in three consecutive 5-year follow-up periods. Specifically, lower values of h-PEF were associated with higher mortality from cardiovascular disease and lung cancer, but not from other cancers. Conclusions A lower value of h-PEF was associated with increased mortality from respiratory and other causes, including lung cancer and cardiovascular disease, but its associations with the other causes of death declined across the follow-up period.

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